BLADDER FUNCTION Storage Voiding

Prof. dr. H. Yunizaf, SpOG(K) Division of Urogynecology Reconstructive Deptment of Obstetrics and Gynecology Faculty of Medicine University of Indonesia Jakarta

Detrusor muscle Sympathetic and parasympathetic Central nerves system


asetilkolin Muscarinic receptor Detrusor muscle

Five pharmacologically defined receptors, M1- M5 Sigala et al 2002 Predominance of M2 and M3 receptors Yamaguchi et al 1996, Sigala et al 2002 M2 receptors predominanc 3:1 over M3 receptors Muscarinic receptors found
Urotelial

cells nerves 2002, Gillespie et al 2003 cells

Suburotelial Interstitial

Chess-Williams

Filling Cystometry (CMG) (Normal)

Namiki M, 1998

Namiki M, 1998

Detrusor overactivity is a urodynamic observation characterised by involuntary detrusor contractions during the filling phase which may be spontaneous or provoked.
1.

Neurogenic detrusor overactivity

When there is a relevant neurogical condition This term replaces the term detrusor hyperreflexia

2.

Idiopathic detrusor overactivity

When there is no defined cause Non-neurogenic This term replaces the term detrusor instability

Unstable detrusor (what is called Unstable bladder, =Detrusor instability) in the previous version (1989) Deleted
Abrams P, Cardozo L et al Neurourol Urodyn 2002;21:167-178 (Page 173 L&R)

Overactive Bladder (OAB) is a symptom syndrome suggestive of lower urinary tract dysfunction It is specifically defined as: Urgency, with or without urge incontinence, Usually with frequency and nocturia Standardisation Subcommittee of the International Continence Society (ICS) OAB is used in the absence of proven infection or other obvious pathology Usually suggestive of detrusor overactivity, but can be due to other urethro-vesical dysfunction.

Abrams P, Cardozo L, Fall M et al Neurourol Urodyn 2002;21:167-178

Urgency Incontinence Frequency Nocturia

A sudden compelling desire to pass urine, which is difficult to defer Any involuntary leakage of urine Voiding too often usually defined as 8 or more times in 24 hours Waking more than once at night to void

Urgency Frequency Nocturia Incontinence urge

Abrams P, Cardozo L, Fall M et al Neurourol Urodyn 2002;21:167-178

SYMPTOM OVERACTIVE BLADDER

Urgency
1

Increased Frequency

Nocturia

and Reduced Intervoid Interval

1

Incontinence

Urgency Frequency

Urge incontinence

Reduced Volume Voided per Micturition

1. Proven direct effect 2. Effect correlated with urgency but inconsistent due to multifactorial etiology of the symptom Chapple C. ICI poster, June 2004

Overactive bladder

DIAGNOSTIC OVERACTIVE BLADDER (OAB)

Urinalysis
1. 2. 3. 4. 5.

HISTORY PHYSICAL EXAMINATION LABORATORY TEST URINARY DIARY URODYNAMICS

to rule out hematuria, pyuria, bacteriuria, glucosuria, proteinuria

Blood

work as appropriate glucose prostate specific antigen others

Fantl JA et al. Agency for Healthcare Policy and Research; 1996; AHCPR Publication No. 96-0686.

CONTOH DAFTAR HARIAN BERKEMIH

KARTU CATATAN BUANG AIR KECIL Hari ke-I Tgl y y y y m m d d

This diary will help you and your healthcare team. Bladder diaries help show the causes of bladder control trouble. The sample line (below) will show you how to use the diary.

Your name: J. Doe Date: March 31, 2003

Interval waktu Tengah malam 1.00

Buang air kecil Biasa

Mengompol

Keinginan buang air kecil

Keadaan

Drinks Time What kind? Sample 67 AM 78 AM 89 AM 910 AM 1011 AM 1112 PM 121 PM 12 PM 23 PM 34 PM 45 PM coffee How much? 2 cups How many times? 12

Urination

Accidental Leaks

Did you feel a strong urge to go?

What were you doing at the time?

How much? (fill in amount: small, medium, large) large

How much? (fill in amount: small, medium, large) large yes

Sneezing, exercising, having sex, lifting, etc. laughing

1.00-2.00 2.00-3.00 3.00-4.00 4.00-5.00 5.00-6.00 6.00-7.00 7.00-8.00 8.00-9.00 9.00-10.00 10.00-11.00 12.00-13.00 13.00-14.00 14.00-15.00 16.00-16.00 16.00-17.00 17.00-18.00 18.00-19.00 19.00-20.00 20.00-21.00 21.00-22.00 22.00-23.00 23,00-24.00

C onservative O perative

1. Konservatif 1. Obat obatan 2. Bladder drill 3. Pesikotrapi 4. Perubahan prilaku 5. Akupunktur 6. Pampers 2. Operatif Neoromudulasi Cystoplasty

THANK YOU