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Voiding dysfunction

Because the prostate surrounds the urethra and has direct connections to it, and also supports the bladder closure, prostate disease and its treatment can interfere with micturition (urination).

Normally, the bladder is filled every 4-7 hours with 350-450ml of urine and thus fully. This leads to a stretching stimulus bladder, can sag at the outlet from the bladder to the internal involuntary sphincter, which manifests itself as a need to urinate. Going to the toilet and relaxes the external, arbitrary sphincter of the pelvic floor, the muscles of the bladder wall contracts.After rapid onset, the bladder emptied so with a maximum flow rate of 20-50ml per second in 10-15 seconds and completely symptom-free (see also uroflowmetry in urine tests ). Is this the end of micturition, urination impaired, one speaks of voiding dysfunction.

Classification
Voiding dysfunction can be broadly divided into three groups:
1 Obstructive characters caused by obstruction of the Harnabflusses from the bladder (of obstruction = laying, eg through the prostate):
  • Delayed Miktionsbeginn.
  • Urine stream to trickle.
  • Extended Miktionsdauer.
  • Dribbling of urine after voiding.
  • Residual urine: sensation of incomplete voiding.
  • Harnstottern: Harnstrahlunterbrechungen, eg by a bladder stone that laid the bladder outlet again.
2 Irritative signs caused by irritation (= irritation, eg irritation of the urinary bladder by residual urine or inflammation = irritable bladder):
  • Dysuria: Painful urination with more difficult micturition. Sometimes used as a term for the irritative signs.
  • Urinary frequency: urinary urgency and voiding during the day heaped, each with a small amount of urine emptying, the daily amount remains the same.
  • Nocturia: micturition urgency, and more than twice per night.
  • Algurie: Painful urination. If there is pain at the end of urination is called a terminal Algurie.
  • Stranguria (dysuria): Very painful urination (bladder spasms), usually with a very small amount of urine emptying.
  • Urgency (engl. urge = urge): Strong, compelling urge to urinate, can lead to urge incontinence (see urinary incontinence ).
3 Urinary incontinence is an involuntary loss of urine and can be caused by different mechanisms. For details, see urinary incontinence .

Causes
The causes of voiding dysfunction are very diverse: for example, inflammation, stones, tumors, vascular lesions, deformities and scars in the region of the kidney, ureter, bladder, prostate and urethra, also nervous and cardiac diseases, and medications.

Are particularly frequent urethral infections and prostate diseases. The latter often obstruct urine flow from the bladder, thus leading to obstructive signs (see above). In the course then irritative signs or even urge incontinence (see come incontinence ) was added when the residual urine or Harnweginfekt irritate the bladder (overactive bladder). See also signs of disease in prostate cancer , signs and complications of BPS (benign prostatic syndrome), acute prostatitis , chronic prostatitis and prostatopathy .

Complications
Voiding dysfunction can lead to many complications, even to permanent kidney damage.Important in the Harnabflussbehinderung (obstruction) by the prostate are:
  • Bubble bar: thickening of the bladder wall, possibly with formation of diverticula (protuberances), and thereby further consequences (eg, stone formation, inflammation).
  • Overflow incontinence: overstretching of the bladder wall by too much residual urine with dribbling (overflow incontinence, see urinary incontinence ) and back pressure in the kidneys (risk of kidney damage).
  • Acute urinary retention (ischuria): A sudden, complete obstruction makes urination impossible and leads to painful over-stretching of the bladder.
More information on these complications also see signs and complications of BPS (benign prostatic syndrome).

Investigation
Because of the numerous possible causes, and voiding dysfunction complications must be carefully determined. In addition to the extensive collection of history (anamnesis) relatively many methods come into consideration (eg, digital rectal examination , urine tests ), so that they can not be described here. The investigation transition at a obstruction by the prostate, while benign prostatic syndrome described in the chapter " examination by BPS . "

Demarcation
Voiding dysfunction should be distinguished from changes in the amount of urine (diuresis):
  • Polyuria (increased urine output): More than 2000ml per day, for example with increased fluid intake, diabetes mellitus and kidney disease, usually is accompanied by urinary frequency (see above).
  • Oliguria (decreased urine output): Less than 500ml per day, for example at a reduced fluid intake and kidney disease. An obstruction by the prostate leads to urinary frequency (see above) and therefore only intended for oliguria, if you drink less because of the discomfort.
  • Anuria ("no" diuresis): Per day get less than 100ml of urine in the bladder, eg in shock and renal failure. Therefore, in case of acute urinary retention (see above) a so-called false anuria.

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