Urethral overactivity

Overflow Urinary Incontinence (OUI) (Urethral Overactivity and/or Bladder Underactivity)4... 

Clinical Presentation of Urinary Incontinence Related to Urethral Overactivity and/or Bladder Underactivity4 ... 

Important but rare type of Ul in both sexes. Urethral overactivity usually due to prostatic enlargement (males) or cys-tocele formation or surgical overcorrection following antiurethral underactivity (SUI) surgery (females). 

Urethral overactivity and/or bladder underactivity is known as overflow incontinence. The bladder is filled to capacity but is unable to empty, causing urine to leak from a distended bladder past a normal outlet and sphincter. Common causes of urethral overactivity include benign prostatic hyperplasia (see Chap. 82) prostate cancer (see Chap. 65) and, in women, cystocele formation or surgical overcorrection after UI surgery. 

Urethral overactivity and/or bladder underactivity is a rare, but important, cause of UI. Patients complain of lower abdominal fullness, hesitancy, straining to void, decreased force of stream, interrupted stream, and sense of incomplete bladder emptying. Patients can also have urinary frequency, urgency, and abdominal pain. 

For urethral overactivity and/or bladder underactivity, digital rectal exam or transrectal ultrasound should be performed to rule out prostate enlargement. Renal function tests should be performed to rule out renal failure. 

CLINICAL PRESENTATION OF URINARY INCONTINENCE RELATED TO URETHRAL OVERACTIVITY AND/OR BLADDER UN DERACTI VITY... 

Urethral overactivity is most commonly cansed by anatomic obstruction. Anatomic obstmction in men is most often caused by benign prostatic enlargement, which is discnssed in Chap. 82. 

Urinary incontinence—Involuntary leakage of urine. May result from urethral underactivity (stress urinary incontinence), urethral overactivity (overflow incontinence), or mixed pathophysiologic mechanisms. 

Mixed incontinence includes the combination of bladder overactivity and urethral underactivity. 

Differentiating Bladder Overactivity from Urethral Underactivity... 

Various types of UI may coexist in the same patient. The combination of bladder overactivity and urethral underactivity is termed mixed incontinence. This is often a difficult diagnosis to make because of the often-confusing array of presenting symptoms. Bladder overactivity may also coexist with impaired bladder contractility. This is most common in the elderly and is termed detrusor hyperactivity with impaired contractility. ... 

A broad spectrum of terms such as nonneuro-pathic vesicourethral dysfunction (Koff 1984), overactivity of the bladder and striated urethral muscle (Van Gool et al. 1984), nonneuropathic or nonneurogenic bladder-sphincter dysfunction (Hoebeke et al. 1999), dysfunctional bladder (Hinman 1986), unstable bladder (Koff 1982), nonneurogenic neurogenic bladder (Allen 1977) and Hinman syndrome (Hinman 1986) is still in use for sometimes overlapping patterns of nonneurogenic bladder-sphincter dysfunction. 

Hoebeke et al. (2001) in a publication about 1,000 videourodynamic studies in children with nonneurogenic bladder dysfunction found urge syndrome (overactive bladder or unstable bladder) in 58% (male female ratio 58 42), dysfunctional voiding (overactivity of the external urethral sphincter) in 32% (male female ratio 49 51) and lazy bladder in 4% (male female ratio 20 80). Furthermore, he found that the age distribution provided evidence against a dysfunction sequence as mentioned above. 

Hansen J, Borau A, Rodriguez A, Vidal J, Sinkjaer T, Rijkhoff NJM (2007) Urethral sphincter EMG as event detector for neurogenic detrusor overactivity. IEEE Trans. Biomed Eng 54(7), July 2007. 

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