Page 1 of 1: surgery - if urine escapes when a patient rises after

decembermist · Credits: 41121 My Scrapbook

completion of urination , which of the following shud be strongly considered ?

a) cystitis
b) neurogenic bladder
c) urethral diverticulum
d) stress incontinence
e) urge incontinence

manpreet108 · Credits: 30682 My Scrapbook

stress incontinence.

on standing abdominal pressure is rising -leading to dribbling -thats a charecteristic of stress incontinenence.

am i rt mist???

decembermist · Credits: 41121 My Scrapbook

ans given is c)

guest · Credits: 78905 My Scrapbook My Reading List 262569 Books

Patients of urethral incontinence may complain of the following symptoms: recurrent urinary tract infections, pelvic pain, incontinence, post-void dribbling, dyspareunia (painful sexual intercourse), dysuria (difficulty voiding), urinary frequency and urgency, nocturia, a feeling of incomplete bladder emptying (urinary retention) or a multitude of other non-specific lower urinary tract symptoms.

Presenting symptoms are classically described as the triad of postvoid dribbling, dysuria, and dyspareunia.

Hopefully this answers ur query

manpreet108 · Credits: 30682 My Scrapbook

yes that definitely solves the ques.

heres a little more info on the topic--

most common symptoms as follows:

Urinary frequency and urgency (40-100%)

Dysuria (30-70%)

Recurrent UTI (30-50%)

Postmicturition urinary dribbling (10-30%)

Dyspareunia (10-25%)

Hematuria (10-25%)

guest · Credits: 78905 My Scrapbook My Reading List 262569 Books

Sorry for writing urethral "incontinence" in my last post, I meant urethral diverticulum.

Anyway here are some more details of this condition.

Urethral diverticula may be clasified into congenital and acquired. The acquired type may be due to the following causes: —
(a) Those arising from perforation of the urethra resulting from injuries or rupture of a peri-urethral abscess or cyst into the urethra. It may also occur after external urethrotomy.
(b) Those arising as a result of asymmetrical dilation of the urethra proximal to some form of obstruction such as a stricture or an impacted calculus
(c) Those arising from the pathological distension of a normal structure such as the sinus pocularia, prostatic and paraurethral ducts.

Acquired diverticula may also follow injury to the nerves supplying the urethral musculature.

Some favour further distinction of the diverticula into true and false. The true diverticula have mucous membrane lining the same as that of the urethra while the false ones are lined by fibrous tissue or columnar epithelium.

ETIOLOGY AND PATHOGENESIS OF CONGENITAL DIVERTICULA

Varioius veiws are:
1). diverticulum and hypospadias are the same developmental defects, i.e. there is a faulty union of the folds of the urethra. In the case of diverticulum only the urethra is at fault while in the case of hypospadias the defect includes the whole thickness including the skin.
2). It is due to primary atrophy of the corpus spongiosum, allowing bulging of the urethra to form a sac on the ventral wall.
3). It is due to a failure of union of the two portions of the urethra, the glandular and the penile. This failure occluded the urinary outflow and caused distension of the urethra. Later on when the urethra became patent, the distended portion remained as a diverticulum.
4). Diverticulum in its own case was due to a congenital stricture of the urethra.
5). The urethra originating from the genital furrow is covered with epidermis. A canal is formed which occupies the position of the future urethral canal. This canal is at first not closed on the side of the ventral surface of the future urethra, and there is a communicating bridge of epithelium connecting with the external skin. Normally the epithelium
bridge is absorbed. It is the failure of absorption of the epithelium bridge that gives rise to diverticula and cysts.

Pathology :
The majority of the congenital diverticula are in the anterior and those of the acquired variety in the posterior urethra. It usually lies in the floor of the urethra and varies from 2 m.m. to 12 c.m. in diameter. It may be spherical or saccular in shape. The orifice may be very small or as large as the diverticulum itself. The inner lining is usually smooth but may be inflamed and ulcerated. The wall may be thin or thick and fibrotic. Microscopically, it may or may not be lined with mucous membrance. When present, it may be of transitional, columnar or squamous cell variety. As a result of stagnation of urine in the sac infection sets in. This may lead to abscess formation and the rupture of which gives rise to haemorrhage and fistula formation. Stones may form in a diverticulum. The obstruction to the outflow of urine, caused by the pressure of the distended sac upon the urethra, may lead to hydroureter, hydro-nephrosis, and in the presence of infection, pyelonephritis and pyonephrosis.

Symptoms:
The symptoms are dependent upon their size, location, and the degree of infection. Small ones usually cause no symptoms. Diverticulum of the anterior ventral urethra usually presents as a palpable tumor which enlarges during micturition and is easily emptied by digital pressure. Stones when present may change the consistency and prevent complete emptying of the sac. Dribbling after micturition is a common symptom. Difficulty in micturition and sometimes acute retention of urine may occur. The symptoms in cases of diverticula of the posterior urethra may simulate that of prostatitis giving rise to deep seated pain in the perineum, low back ache and dysuria. A stubborn urethritis is a prominent symptom in those cases complicated by stone formation.

Diagnosis:
The diagnosis can be readily made from the history and physical examination. The use of urethrogram and endoscopy confirms the presence as well as determines the details of a diverticulum.

Treatment:
1). Campbell states that small diverticula with good drainage may, in many instances, be left alone.
2). McKay and Colston reported two types of operative treatment for large diverticula.
a). Resection of the sac and repair of the urethra is the treatment of choice for those arising in the anterior urethra.
b). For posterior urethral diverticula they recommend the removal of the roof of the diverticulum so as to convert the diverticulum and the prostatic urethra into one cavity and thus facilitates proper drainage and prevents over distentdon of the diverticulum.

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