上海交通大学：《诊断学》课程PPT教学课件（英语版）INCONTINENCE OF URINE BASIC COURSE OF DIAGNOSIS

INCONTINENCE OF URINE BASIC COURSE OF DIAGNOSIS Xiaoqi Xu Renji hospital Shanghai Second Medical University 回一一一一一一一一一一一一一 2002.04.19

INCONTINENCE OF URINE BASIC COURSE OF DIAGNOSIS Xiaoqi Xu Renji Hospital Shanghai Second Medical University 2002.04.19

CONTENT ※ Definition x Etiology and clinical appearance x Accompanied symptoms Approach to the patient

CONTENT Definition Etiology and clinical appearance Accompanied symptoms Approach to the patient

DEFINITION x Inability to retain urine in the bladder, result from neurologic or mechanical disorder of the system that control normal micturition xx Loss of the urine through channnels other than the urethra(ectopic ureter, fistulae) and severe tu bercular cystitis (contracture of bladder)are rare but cause total or continuous incontinence

DEFINITION Inability to retain urine in the bladder, result from neurologic or mechanical disorder of the system that control normal micturition. Loss of the urine through channnels other than the urethra (ectopic ureter,fistulae) and severe tubercular cystitis (contracture of bladder) are rare but cause total or continuous incontinence

ETIOLOGY AND CLINICAL APPEARaNcE 兴True incontinence 兴 Overflow or paradoxical incontinence 兴 Stress incontinence 兴Urge incontinence

ETIOLOGY AND CLINICAL APPEARANCE True incontinence Overflow or paradoxical incontinence Stress incontinence Urge incontinence

TTrue incontinence The spinster of the bladder and urethra becomes prone to uncontrolled because normal pathways are damaged. diseases of the central nervous system cerebrovascular accidents Alzheimer 's disease neoplasm

True incontinence The spincter of the bladder and urethra becomes prone to uncontrolled because normal pathways are damaged. diseases of the central nervous system: cerebrovascular accidents Alzheimer’s disease neoplasm

Overflow or paradoxical incontinence Large residual volumes of urine secondary to obstruction at the bladder neck or the urethra(urethral stricture). benign prostatic hyperplasia 一75%0 ld man

Overflow or paradoxical incontinence Large residual volumes of urine secondary to obstruction at the bladder neck or the urethra (urethral stricture). benign prostatic hyperplasia —75% old man

Stress incontinence postmenopausal parous woman parturition may damage the pelvic support of the bladder so that the bladder and the urethra can slip downward from their normal position above the pelvic di dlaphragm the urethra shortens the normal urethrovesical angle is lost(closing the urethral sphincter) women unable to resist the passage of urine under the stress of increased intra-abdominal pressure during coughing sneezing, climbing strains and other physical activity, small amount of urine escape

Stress incontinence -postmenopausal parous woman parturition may damage the pelvic support of the bladder so that the bladder and the urethra can slip downward from their normal position above the pelvic diaphragm the urethra shortens,the normal urethrovesical angle is lost(closing the urethral sphincter) women unable to resist the passage of urine under the stress of increased intra-abdominal pressure during coughing,sneezing,climbing strains and other physical activity,small amount of urine escape

Urge incontinence An involuntary loss of urine associated with a strong desire to void. bacterial cystitis bladder cancer bladder outlet obstruction neurogenic bladder

Urge incontinence An involuntary loss of urine associated with a strong desire to void. bacterial cystitis bladder cancer bladder outlet obstruction neurogenic bladder

Accompanied symptoms x with progressive straining to void over 50y: prostatic hyperplasia, prostate cancer x with symptoms and signs in neurologic system: neurogenic bladder x with irritation sign of bladder and pyuria acute cystitis

Accompanied symptoms with progressive straining to void over 50y: prostatic hyperplasia, prostate cancer with symptoms and signs in neurologic system: neurogenic bladder with irritation sign of bladder and pyuria: acute cystitis

Approach to the patient history Onset, duration, evolution, triggering events ofleakage severity, amount and type of fluid consumed, sexual history, past urologic history I→ DIAGNOSIS physical examination emphasis on the a bdominal genital, pelvic, neurologic system complex testings

Approach to the patient history Onset,duration,evolution,triggering events of leakage severity, amount and type of fluid consumed, sexual history, past urologic history physical examination emphasis on the abdominal, genital,pelvic,neurologic system complex testings DIAGNOSIS