Voiding Disorders in Patients with Cerebrovascular Accident

Background: Cerebrovascular accident often happens in elderly group, frequently causing voiding dysfunction. The aim of the study was to determine the magnitudes of various types of voiding disorders among patients of cerebrovascular accidents attending in Dhaka Medical College Hospital. Methods: It was a cross-sectional study conducted at the department of Urology ofDhaka Medical College Hospital from July 2009 to June 2011. Hundred and eight patients were enrolled in the study. Results: More than 61% subjects were male (n=66).Leading number of patients (45.4%) had three to six months disease duration. In this group 67.3% had overactive bladder, 64.7% had underactive bladder and 24.5% had normal activity of bladder. In patients with irritative symptoms majority had overactive bladder (71.4%) while in patients with obstructive symptoms half of the subjects had overactive bladder (50.0%). Majority of the subjects with DM (71.4%) and HTN (82.6%) had overactive bladder. Seventy percent (n=) subjects with overactive bladder had arterial stroke while around 82% (n=) of the underactive bladder subjects had venous stroke. More than 85% subjects with underactive bladder and around 78% subjects with overactive bladder had infection. Conclusion: Voiding dysfunction is a common sequel of acute stroke and most of the patients with irritative symptoms and about half of the subjects with obstructive symptoms had overactive bladder. Diabetes mellitus, hypertension and arterial stroke were found to be associated with overactive bladder. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.136-141

Voiding Disorders in Pediatrician’s Practice

Voiding disorders result usually from functional disturbance. However, relevant organic diseases must be excluded prior to diagnosis of functional disorders. Additional tests, such as urinalysis or abdominal ultrasound are required. Further diagnostics is necessary in the presence of alarm symptoms, such as secondary nocturnal enuresis, weak or intermittent urine flow, systemic symptoms, glucosuria, proteinuria, leukocyturia, erythrocyturia, skin lesions in the lumbar region, altered sensations in the perineum. Functional micturition disorders were thoroughly described in 2006, and revised in 2015 by ICCS (International Children’s Continence Society) and are divided into storage symptoms (increased and decreased voiding frequency, incontinence, urgency, nocturia), voiding symptoms hesitancy, straining, weak stream, intermittency, dysuria), and symptoms that cannot be assigned to any of the above groups (voiding postponement, holding maneuvers, feeling of incomplete emptying, urinary retention, post micturition dribble, spraying of the urinary stream). Functional voiding disorders are frequently associated with constipation. Bladder and bowel dysfunction (BBD) is diagnosed when lower urinary tract symptoms are accompanied by problems with defecation. Monosymptomatic enuresis is the most common voiding disorder encountered by pediatricians. It is diagnosed in children older than 5 years without any other lower urinary tract symptoms. Other types of voiding disorders such as: non-monosymptomatic enuresis, overactive and underactive bladder, voiding postponement, bladder outlet obstruction, stress or giggle incontinence, urethrovaginal reflux usually require specialized diagnostics and therapy. Treatment of all types of functional voiding disorders is based on non-pharmacological recommendations (urotherapy), and such education should be implemented by primary care pediatricians.

How far are they coming from?

Introduction: In the province of Quebec, eight pediatric urologists practice in three tertiary centres covering large territories. To improve the availability of pediatric urology to distant families and to reduce the economic burden on them, we examined the chart of all patients attending the pediatric urological outpatient clinic. Our objectives were to evaluate the distance travelled by each urological pediatric outpatient and to report the most frequent urological referral complains. Methods: From July 2016 to June 2017, we retrospectively reviewed the charts of all the 3609 pediatric patients seen in the outpatient urological clinic in CHU de Québec. We specifically focused on the travelling distance covered by families and the purpose of referral. Results: Most patients were boys (78%) and the mean age was 7.2 years. The average one-way distance traveled by each family was 69 km. The patients came more frequently from Capitale-Nationale (63,7%) and Chaudière-Appalaches (21,9%), the closest regions. The most common reasons for consultations were postoperative followups (15%), phimosis and adherences (14%), enuresia (14%), hydronephrosis (13%), micturition disorder (11%), and cryptorchidism and retractile testicles (8%). Of all patients seen for phimosis or cryptorchidism, only 24% and 36% of them, respectively, were scheduled for surgery. Conclusions: Phimosis, cryptorchidism, and voiding disorders are the most frequent pediatric urological reasons for consultation; primary care continuing medical education seems worthwhile. It would, perhaps, be more beneficial for all to have the pediatric urologists travelling to perform clinics and surgeries in distant regions to save more than 300 km round trip to several families.