Dysfunctional Voiding Patterns
Dysfunctional voiding presents in the form of urinary incontinence or urine retention. Urinary incontinence is the unplanned loss of urine that is sufficient to be considered a problem. Urinary conti-nence relies on intact urinary, neurologic, and musculoskeletal sys-tems. Continence is maintained via a complex communication system of suprasacral, sacral, and local nerve-mediated loops of information, all of which must be functioning efficiently and syn-ergistically. Any break in these loops of communication (for ex-ample, an upper or lower neuron lesion, spinal stenosis, or bladder outlet obstruction) can cause some degree of urinary dysfunction. Depending on the location of the insult, both incontinence and incomplete bladder emptying can occur. Anatomic integrity of the upper and lower urinary system must be intact; otherwise, urine extravasation into the peritoneal or perivesical cavity (as seen in acute trauma) or extraurethral incontinence (as seen in some forms of congenital malformations) will occur. Genitourinary fistula formation between the bladder wall and other areas, such as the vagina, will result in extraurethral incontinence. The etiology of dysfunctional voiding can be congenital or acquired in adulthood. Each is reviewed separately
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