Lower urinary tract injury

The patient usually notes Ul during activities like exercise, running, lifting, coughing, or sneezing. This type of Ul is much more common in females (seen only in males with lower urinary tract surgery or injury compromising the sphincter). 

Spasticity is a central feature of multiple sclerosis (MS) and spinal cord injury (SCI). It consists of a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex as one component of the upper motor syndrome (Young 1994). Existing drug therapy is far from satisfactory in terms of efficacy and unwanted effects (Panegyres 1992). Tremor, ataxia and lower urinary tract symptoms are frequently troublesome in MS. Both neuropathic and nociceptive pain (dealt with in Sect. 2.3) are also common in MS and SCI, and dozens of very painful muscle spasms can occur each day. Small wonder that there is also a high incidence of anxiety and depression in these conditions. 

In men, SUI is most commonly the result of prior lower urinary tract surgery or injury, with resulting compromise of the sphincter mechanism within and external to the urethra. Radical prostatectomy for treatment of adenocarcinoma of the prostate is probably the most common setting in which surgical manipulation leads to UI. Overall, SUI in the male is uncommon, and in the absence of prior prostate surgery, severe trauma, or neurologic illness, is extraordinarily rare. Transurethral resection of the prostate for benign prostatic hyperplasia (see Chap. 82) may also lead to SUI in men. 

Prior surgery may have effects on lower urinary tract function. UI following prostate surgery in men is very suggestive of injury to the... 

FIGURE 43.2 Cartoon of the nephron and lower urinary tract showing sites of injury caused by various chemical and biological warfare agents (A, afferent arteriole G, glomerulus B, Bowman s capsule P, proximal tubule L, loop of Henle D, distal tubule C, collecting ducts R, renal pelvis UR, ureter UB, urinary bladder UA, urethra). 

The lower US rates might reflect better quality care, but most probably reflect the narrower focus on negligent injury rather than the broader quality improvement focus of most other studies (Thomas et al, 2000a). Eric Thomas and colleagues also found, in a careful comparison of specific types of adverse events, that Australian reviewers reported many more minor expected or anticipated complications, such as wound infection, skin injury and urinary tract infection. These are adverse events by the strict definition of the term, but were not included by the American reviewers, who were focusing on more serious injuries (Thomas et al, 2000a). 

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