Micturition abnormal

From a therapeutic point of view, it is essential to confirm the presence of bacteriuria (a condition in which there are bacteria in the urine) since symptoms alone are not a reliable method of documenting infection. This applies particularly to bladder infection where the symptoms of burning micturition (dysuria) and frequency can be associated with a variety of non-bacteriuric conditions. Patients with symptomatic bacteriuria should always be treated. However, the necessity to treat asymptomatic bacteriuric patients varies with age and the presence or absence of underlying urinary tract abnormalities. In the pre-school child it is essential to treat all urinary tract infections and maintain the urine in a sterile state so that normal kidney maturation can proceed. Likewise in pregnancy there is a risk of infection ascending from the bladder to involve the kidney. This is a serious complication and may result in premature labour. Other indications for treating asymptomatic bacteriuria include the presence of underlying renal abnormalities such as stones which may be associated with repeated infections caused by Proteus spp. 

Significant adverse reactions include fatigue headache drowsiness paresthesias difficulty in micturition diarrhea reversible increases in serum transaminases dyspnea bronchospasm asthenia muscle cramps nausea vomiting fever with aching and sore throat toxic myopathy rashes systemic lupus erythematosus vision abnormality hypoesthesia ventricular arrhythmias intensification of AV block mental depression scalp tingling. 

This may be found by routine urine testing of pregnant women or patients with known structural abnormalities of the urinary tract. Such infection may explain micturition frequency or incontinence in the elderly. Appropriate antimicrobial therapy should be given, chosen on the basis of susceptibility tests, and normally for 7-10 days. Amoxicillin or a cephalosporin is preferred in pregnancy, although nitrofurantoin may be used if imminent delivery is not likely (see below). 

Drugs that may be used to alleviate abnormal micturition... 

The type of urine specimen to be collected is dictated by the tests to be performed. Untimed or random specimens are suitable for only a few chemical tests usually, urine specimens must be collected over a predetermined interval of time, such as 1,4, or 24 hours. A clean, early morning, fasting specimen is usually the most concentrated specimen and thus is preferred for microscopic examinations and for the detection of abnormal amounts of constituents, such as proteins, or of unusual compounds, such as chorionic gonadotropin. The clean timed specimen is one obtained at specific times of the day or during certain phases of the act of micturition. Bacterial examination of the first 10 mL of urine voided is most appropriate to detect urethritis, whereas the midstream... 

Miosis may also occur as a systemic feature, although more usually it follows direct exposure. This explains why, for example, modest dermal exposure may produce systemic features but not miosis. Abdominal pain, nausea and vomiting, involuntary micturition and defecation, muscle weakness and fasciculation, tremor, restlessness, ataxia and convulsions may follow dermal exposure, inhalation or ingestion of a nerve agent. Bradycardia, tachycardia and hypertension may occur, dependent on whether muscarinic or nicotinic effects predominate. If exposure is substantial, death may occur from respiratory failure within minutes, whereas mild or moderately exposed individuals usually recover completely, although EEG abnormalities have been reported in those severely exposed to sarin in Japan (Murata etal., 1997 Sekijima et al., 1997). 

Fig. 1.1.6. VCU in a 7-year-old boy who complained of dys-uria. Oblique view during micturition. Slightly irregular bladder cannot be interpreted as abnormal during micturition. Bladder diverticulum (the same was shown on the opposite side). Moderate dilatation of the posterior urethra. Valves were suspected. Cystoscopy confirmed the diagnosis, and coagulation was performed. However, the orifices of the diverticula were not seen by the surgeon...

Extremely rare in childhood, the urethral polyp is usually solitary and consists of a pedunculated structure, originating from the posterior urethra, developing in the bladder neck, which can prolapse in the urethra during micturition (Foster and Garrett 1986). Hematuria, nonneurogenic bladder-sphincter dysfunction and infection may reveal the abnormality. On ultrasound, it appears echo-genic. The main differential diagnosis of urethral polyp is an ectopic ureterocele that has ruptured either spontaneously (Fig. 6.8) or after endoscopic... 

Fig. 6.7. a VCU in a 7-year-old boy with dysuria, showing extrinsic compression of the urethra due to abnormal sphincter contraction during micturition. This functional anomaly should not be mistaken for posterior urethral valves. Urody-namic studies favor dysfunctional voiding with bladder-sphincter dyscoordination during voiding. Biofeedback physiotherapy was carried out. Clinical outcome was favorable, b Follow-up VCU shows normalization of urethral anatomy during... 

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