F00574 017 f014

Normal Storage micturition cycle Voiding	Minimal pressure rise in bladder as it fills. No detrusor activity, sphincter muscle tonę increased during filling Sphincter relaxes, detrusor contracts and vesical pressure increases. Good urine ftow until bladder empty
Stress incontinence	As for normal but during cough there is passive increase in the vesical pressure (no active detrusor contraction). This vesical pressure is greater than urethral pressure transiently with resultant urine leakage
Urgo incontinence	As for normal but during filling there is abnormal detrusor contraction; this results in a raised vesical pressure. and if this is greater than the urethral pressure, leakage occurs
Overflow incontinence	Bladder is very fuli. No detrusor contractions but minimal increases in abdominal and vesical pressure result in urine leakage (as in stress incontinence)
Prostatic obstruction	This shows only the voiding phase; the storage phase is the same as the normal. During voiding there is a strong detrusor contraction resulting in high vesical pressure. Despite this high pressure there is poor flow because of the obstruction in the prostatic urethra. Flow is typically wavy as the prostatic obstruction is somewhat elastic and varies throughout the void

© Elsevier. Boon et al.: Davidson's Principles and Practice of Medicine 20e - www.studentconsult.com