Voiding disorder
| Classification according to ICD-10 | |
|---|---|
| R39.1 | Other micturition disorders
Split urine stream. Weak urine stream. Delayed urination |
| ICD-10 online (WHO version 2019) | |
A bladder emptying disorder is a disorder that manifests itself in difficult or incomplete emptying of the urinary bladder , which cannot be started arbitrarily or which is far too rare . Mechanical, functional, neurological diseases or psychogenic factors are possible causes. The result is often a frequent leakage of smaller amounts of urine (a so-called overflow bladder ) with residual urine formation or a urinary congestion . Such frequent leakage of urine that cannot be deliberately influenced is also known as incontinence .
Difficult urination is known as dysuria . Residual urine formation and catheterization are favorable factors for the development of a urinary tract infection .
The inability to empty the bladder by yourself due to slackening of the bladder muscles is known as bladder atonia . This atony can occur after radical pelvic surgery or as part of an anticholinergic syndrome , e.g. B. by poisoning with atropine . According to the established medical knowledge of neuro-urology and urogynecology, such a bladder atony can also arise in the postoperative period of a hysterectomy (more often with vaginal uterine removal than with abdominal uterine removal) due to an overstretching of the urinary bladder. Bladder atony means that the bladder is completely paralyzed (bladder paralysis) and its storage and emptying functions are severely impaired.
A prolonged increase in bladder pressure due to increased contraction of the bladder wall against resistance or as a result of a coordination disorder can lead to bladder wall hypertrophy.
A severe or complete voiding disorder requires immediate catheterization of the bladder. Since hysterectomies (removal of the uterus) often lead to bladder emptying disorders, bladder function and its ability to empty must be carefully and repeatedly checked by the responsible doctor immediately after the hysterectomy.
Mechanical causes
A mechanical obstruction is caused by a morphologically-anatomically definable flow obstacle. In that part of the urinary tract that is in front of the obstacle, there is thus an increase in pressure.
The following can be responsible:
- a pronounced buttonhole phimosis ,
- a meatus stenosis ,
- Urethral strictures ,
- a urethral valve ,
- a benign prostatic hyperplasia (BPH) or prostate carcinoma (PCA),
- a stenosis of the bladder neck ,
- Bladder stones ,
- an ectopic ureterocele .
Neurogenic causes
If the nerve supply to the urinary bladder or the coordination between the contraction of the bladder wall and the subsequent relaxation of the bladder sphincter (occlusive muscle) is disturbed, the result is a neurogenic bladder . Usually there is damage to the spinal cord, e.g. B. paraplegia , MMC , less often damage to the nerve plexus in front of the sacrum (presacral plexus) or in the context of a Fowler-Christmas-Chapple syndrome . However, there may also be an overstretched bladder that has arisen in connection with a hysterectomy. Since the nerve supply to the bladder is disturbed due to the overstretching of the bladder, these cases are also referred to as neurogenic bladders or neurogenic voiding disorders.
Diagnosis
In addition to the clinical examination, an imaging sonography can document a large part of the causes as well as the extent of a possible bladder wall hypertrophy as well as possible effects on the urinary tract lying in front such as widening of the ureter or renal pelvis . By means of a micturition cystourethrogram , vesicorenal reflux , morphology of the urinary tract and any diverticula can be detected and the functional emptying process of the urinary bladder can be assessed. A urodynamic examination (bladder manometry) allows a functional assessment of the emptying process.
literature
- W. Pschyrembel: Clinical Dictionary. 265th edition. Verlag Walter de Gruyter, Berlin 2014, ISBN 978-3-11-018534-8 .
- W. Schuster, D. Färber (Ed.): Children's radiology. Imaging diagnostics. Springer, 1996, ISBN 3-540-60224-0 , p. 706.
Individual evidence
- ^ V. Hofmann, KH Deeg, PF Hoyer: Ultrasound diagnostics in paediatrics and pediatric surgery. Textbook and atlas. Thieme, 2005, ISBN 3-13-100953-5 .
See also
- Hinman syndrome or "non-neurogenic neurogenic bladder" (NNNB)
- Urinary retention
