Urinary Obstruction and Stasis

Garzon, Gatchalian, Gaw, Geraldoy, Geronimo, Geronimo, Geronimo, Go

Section BJuly 7, 2009

• Body – major part of the bladder in which the urine collects

• Neck – funnel-shaped extension of the body

• Detrussor Muscle – its contraction causes an increase in intravesical pressure – Its contraction is the major step in emptying

the bladder

Physiologic Explanation of Symptoms of Bladder Neck

Obstruction

Bladder Neck Obstruction

• Hypertrophy of the vesical musculature– Increase in intravesical pressure (50-100 cm

H2O)– Overcome resistance caused by the

obstructed outlet

Compensatory Phase

• Stage of Irritability

• Stage of Compensation

Decompensation Phase

• Acute Decompensation

• Chronic Decompensation

Compensatory Phase

• Stage of Irritability

• Stage of Compensation

Decompensation Phase

• Acute Decompensation

• Chronic Decompensation

Stage of Irritability

• Force and size of the urinary stream normal – Balance between bladder contraction and

urethral resistance

• Bladder hypersensitive– Strong contractions → spasm – Distension → immediately need to avoid

(normally voiding can be delayed)

Earliest Symptoms of Irritable Bladder

• Urgency → Incontinence

• Frequency– Both may occur day and night

Compensatory Phase

• Stage of Irritability

• Stage of Compensation

Decompensation Phase

• Acute Decompensation

• Chronic Decompensation

Stage of Compensation

• ↑Obstruction, ↑ Hypertrophy = maintain complete bladder emptying

• Urgency, frequency + hesitancy– Hesitancy causes px to strain to force the urine

through the obstruction

• ↑ ↑ Obstruction, ↑ ↑ Resistance

= ↓force and size of stream (<20mL/s)

= slow vesical emptying near completion (exhaustion of detrusor; end of contraction)

Compensatory Phase

• Stage of Irritability

• Stage of Compensation

Decompensation Phase

• Acute Decompensation

• Chronic Decompensation

Acute Decompensation

• Increased difficulty in urination

• Marked hesitancy

• Straining to initiate urination

• Very weak and small stream

• Residual urine

• Acute and sudden complete urinary retention

Compensatory Phase

• Stage of Irritability

• Stage of Compensation

Decompensation Phase

• Acute Decompensation

• Chronic Decompensation

Chronic Decompensation

• Increase in residual volume

• Frequency

• Bladder overstretched and attenuated (1000-3000 mL of urine; normal capacity = 400mL)

• Paradoxic/Overflow Incontinence – intravesical pressure = urethral resistance– urine then constantly dribbles forth