1

Prof. dr. H. Yunizaf, SpOG(K)

Division of Urogynecology Reconstructive

Deptment of Obstetrics and Gynecology

Faculty of Medicine University of Indonesia

Jakarta

BLADDER FUNCTION

Storage

Voiding

Detrusor muscle

Sympathetic and parasympathetic

Central nerves system

2

Muscarinic receptor

Detrusor muscle

asetilkolin

Five pharmacologically defined receptors, M1- M5 Sigala et al 2002

Predominance of M2 and M3 receptors Yamaguchi et al 1996,

Sigala et al 2002

M2 receptors predominanc 3:1 over M3 receptors

Muscarinic receptors found

Urotelial cells

Suburotelial nerves

Interstitial cells

Chess-Williams 2002, Gillespie et al 2003

Filling Cystometry

(CMG) (Normal)

Namiki M, 1998

Namiki M, 1998

3

Detrusor overactivity is a urodynamic observation characterised by

involuntary detrusor contractions during the filling phase which may be

spontaneous or provoked.

1. Neurogenic detrusor overactivity

When there is a relevant neurogical condition

This term replaces the term detrusor hyperreflexia

2. Idiopathic detrusor overactivity

When there is no defined cause Non-neurogenic

This term replaces the term detrusor instability

Unstable detrusor (what is called Unstable bladder, =Detrusor instability) in

the previous version (1989) Deleted

Abrams P, Cardozo L et al Neurourol Urodyn 2002;21:167-178 (Page 173 L&R)

Overactive Bladder (OAB) is a symptom syndrome suggestive of lower

urinary tract dysfunction

It is specifically defined as:

Urgency, with or without urge incontinence, Usually with frequency and nocturia

Standardisation Subcommittee of the International Continence Society

(ICS)

OAB is used in the absence of proven infection or other obvious pathology

Usually suggestive of detrusor overactivity, but can be due to other urethro-vesical dysfunction.

Abrams P, Cardozo L, Fall M et al Neurourol Urodyn 2002;21:167-178

Urgency A sudden compelling desire to pass

urine, which is difficult to defer

Incontinence Any involuntary leakage of urine

Frequency Voiding too often usually defined as 8

or more times in 24 hours

Nocturia Waking more than once at night to void

Abrams P, Cardozo L, Fall M et al Neurourol Urodyn 2002;21:167-178

Urgency Frequency Nocturia Incontinence urge

4

1

1

Increased Frequency

and Reduced

Intervoid Interval

Nocturia

Urgency

Incontinence

Reduced Volume Voided per Micturition

2 2

1. Proven direct effect 2. Effect correlated with urgency but inconsistent due to

multifactorial etiology of the symptom

Chapple C. ICI poster, June 2004

Frequency

Urgency

Overactive bladder

Urge

incontinence

SYMPTOM OVERACTIVE

BLADDER

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1. HISTORY

2. PHYSICAL EXAMINATION

3. LABORATORY TEST

4. URINARY DIARY

5. URODYNAMICS

DIAGNOSTIC OVERACTIVE

BLADDER (OAB)

Fantl JA et al. Agency for Healthcare Policy and Research;

1996; AHCPR Publication No. 96-0686.

Urinalysis

to rule out hematuria, pyuria, bacteriuria, glucosuria, proteinuria

Blood work as appropriate

glucose

prostate specific antigen

others

Time

Drinks Urination Accidental Leaks

Did you feel

a strong

urge to go?

What were you doing

at the time?

What

kind?

How

much?

How many

times?

How much?

(fill in amount:

small, medium, large)

How much?

(fill in amount:

small, medium, large)

Sneezing, exercising,

having sex, lifting, etc.

Sample coffee 2 cups 12 large large yes laughing

67 AM

78 AM

89 AM

910 AM

1011 AM

1112 PM

121 PM

12 PM

23 PM

34 PM

45 PM

This diary will help you and your healthcare team. Bladder diaries help show the causes of bladder control trouble. The sample line (below) will show you how to use the diary.

Your name: J. Doe Date: March 31, 2003

CONTOH DAFTAR HARIAN BERKEMIH

KARTU CATATAN BUANG AIR KECIL Tgl

Hari ke-I y y y y m m d d

Interval waktu Buang air kecil

Biasa Mengompol

Keinginan buang air kecil Keadaan

Tengah malam 1.00

1.00-2.00

2.00-3.00

3.00-4.00

4.00-5.00

5.00-6.00

6.00-7.00

7.00-8.00

8.00-9.00

9.00-10.00

10.00-11.00

12.00-13.00

13.00-14.00

14.00-15.00

16.00-16.00

16.00-17.00

17.00-18.00

18.00-19.00

19.00-20.00

20.00-21.00

21.00-22.00

22.00-23.00

23,00-24.00

Conservative

Operative

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1. Konservatif 1. Obat obatan 2. Bladder drill 3. Pesikotrapi 4. Perubahan prilaku 5. Akupunktur 6. Pampers

2. Operatif Neoromudulasi Cystoplasty

THANK YOU