Urinary disturbance

Urination disorder is a common symptom of urological diseases. It may indicate a serious problem in the genitourinary system.

The following types of urination disorders are distinguished.

Forms

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Acute urinary retention

Acute urinary retention is a urination disorder characterized by the absence of urination when there is an urge to urinate and when the bladder is full. There is severe pain due to overstretching of the bladder during unsuccessful attempts to urinate. The stretched bladder appears as a large elastic spherical tumor in the lower abdomen. Percussion reveals dullness, sometimes extending to the navel and above. Acute urinary retention is observed in transverse spinal cord lesions (the first days of infectious and traumatic injuries), prostate adenoma and cancer, postoperative conditions, the presence of a stone and a tumor of the urethra.

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Urinary retention

Urinary retention may be a consequence of:

1. diseases and injuries of the central nervous system (multiple sclerosis, tumors of the brain and spinal cord, traumatic injuries of the spinal cord and spine, transverse myelitis, tabes dorsalis);
2. the effect of drugs - atropine, ganglionic blockers, narcotic drugs;
3. psychogenic (hysterical) conditions;
4. damage to the genitourinary organs.

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Imperative urges

A disorder of urination, which is characterized by the fact that, despite the urge, the patient cannot delay emptying the bladder for a long time. Imperative urges are most often observed with partial damage to the lateral columns of the spinal cord (multiple sclerosis), with acute cystitis, adenoma and prostate cancer, and tumors of the neck of the bladder.

Enuresis

Enuresis is a urination disorder characterized by sudden, uncontrolled emptying of the bladder. Although it is often classified as nocturnal enuresis, enuresis can occur during the day or night, so a distinction should be made between nocturnal and diurnal enuresis. This type of incontinence is usually seen in children and the elderly; it is caused by the absence of cortical inhibition of the urination reflex. Nocturnal enuresis occurs in early childhood, less often in schoolchildren and adolescents. Boys are affected more often than girls.

Such children exhibit irritability, touchiness, tearfulness, and very deep night sleep. With age, enuresis gradually decreases and passes by puberty. The causes of nocturnal enuresis are most often mental trauma, improper upbringing of the child in the early years with insufficient instillation of the necessary skills. Nocturnal enuresis can be observed in case of water metabolism disorders (polydipsia, polyuria), chronic diseases with deterioration of the general condition of the body (infection, rickets, nutritional disorders, etc.), developmental anomalies of the spine and spinal cord (non-closure of the sacral and lumbar vertebrae, myelodysplasia), pathological processes in the urinary tract (cystitis, phimosis, narrowing of the urethra), in the presence of adenoid growths and intestinal parasites, disruption of night sleep with excessive sleep.

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Polyuria

Polyuria is a urination disorder characterized by an increase in daily diuresis to 3000 ml or more. Polyuria resulting from oral intake or intravenous infusions of large amounts of fluid is benign and temporary. At the same time, persistent polyuria can also occur with a number of nephrogenic, neurogenic, and psychogenic disorders.

Causes of polyuria:

1. primary polydipsia (when drinking large amounts of liquid), water metabolism disorder;
2. diabetes insipidus - neurogenic and nephrogenic;
3. salt diuresis: additional intake of salts, use of large doses of isotonic solutions;
4. osmotic diuresis: diabetic hyperglycemia, prolonged mannitol infusion;
5. natriuretic syndromes (salt wasting, inability to retain sodium) in cystic lesions of the renal medulla, use of diuretics.

Oliguria

Oliguria is a urination disorder characterized by diuresis of less than 400 ml/day. Oliguria is usually considered taking into account its division into prerenal (due to insufficient kidney perfusion), renal (caused by diseases of the kidneys themselves) and postrenal (caused by extrarenal causes, including neurogenic).

In case of paresis of the urinary bladder (multiple sclerosis, spinal cord tumors, funicular myelosis, tabes dorsalis), disorders of not excretion, but only emptying are observed.

In Parhon syndrome (excessive secretion of vasopressin), oliguria is also observed.

Pollakiuria

Pollakiuria is frequent urination. If pollakiuria is not a consequence of polyuria, then it is usually characteristic of diseases of the uropoietic apparatus and psychogenic dysuria. This urination disorder can be observed in healthy people under the influence of cold, excitement, humidity, alcohol, psychogenic disorders, inflammatory diseases of the urethra and bladder, the presence of stones in the bladder, and diseases of the prostate gland. The beginning enlargement of the prostate gland primarily causes frequent urges to urinate at night.

Nocturia

Nocturia is a urination disorder characterized by the predominance of nocturnal diuresis over daytime diuresis due to the amount of urine and the frequency of urination. It is observed in syndromes of autonomic insufficiency, accompanied by denervation of the juxtaglomerular apparatus of the kidneys, in psychogenic disorders, in the early stages of chronic renal failure.

Urination disorders: classifications

Currently, the following four classifications of urination disorders are used in practice.

Classification of N. O. K. Gibbon (1976) is based on a neurological, topical approach

Urination disorder due to suprasacral lesion.

Urination disorder due to sacral lesion:

1. Motor impairment.
2. Sensory impairment.
3. Motor and sensory impairment.

Mixed defeat.

Urination disorders: classification by I. McLellan (1939), revised by J. Lapides (1970)

The following clinical and physiological manifestations form the basis:

1. Sensory neurogenic bladder.
2. Motor paralytic bladder.
3. Uninhibited neurogenic bladder.
4. Reflex neurogenic bladder.
5. Autonomous neurogenic bladder.

Urination disorder: classification by R.J.Krane, M.strong.Siroky (1979)

The classification uses urodynamic data and is broader than the neurological one.

I. Detrusor hyperreflexia (or normoflexia):

1. Sphincter coordination.
2. Dyssynergia of the striated sphincter.
3. Dyssynergia of the smooth muscle sphincter.
4. Non-relaxing smooth muscle sphincter.

II. Detrusor areflexia:

• Sphincter coordination.
• Non-relaxing striated sphincter.
• Denervation of the striated sphincter.
• Non-relaxing smooth muscle sphincter.

In Ukraine, it is customary to distinguish the following forms of urinary disorders

1. Reflex bladder.
2. Hyperreflexive bladder.
3. Hyporeflexive bladder.
4. Areflexic bladder.

Further schematizing the urination disorder, it can be considered that for damage to the suprasegmental parts of the nervous system, the so-called uninhibited bladder (reflexive or hyperreflexive) is characteristic, and for damage localized within the peripheral reflex arc, the autonomous (hyporeflexive) bladder is characteristic.