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National Clinical Guideline Centre (UK). Urinary Incontinence in Neurological Disease: Management of Lower Urinary Tract Dysfunction in Neurological Disease. London: Royal College of Physicians (UK); 2012 Aug. (NICE Clinical Guidelines, No. 148.)

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Urinary Incontinence in Neurological Disease: Management of Lower Urinary Tract Dysfunction in Neurological Disease.

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Glossary: clinical

Alpha-blockers(Alpha adrenergic antagonists)

(Also known as alpha adrenergic blocking agents or alpha adrenergic antagonists): drugs that inhibit the response to sympathetic impulses by blocking the alpha receptor sites of effector organs. Also known as alpha adrenergic blocking agents or alpha adrenergic antagonists. Because they inhibit the contraction of non-vascular smooth muscle such as the trigone and sphincter muscles of the urinary bladderthat found at the bladder neck and within the prostate, aAlpha-blockers are sometimescommonly used to treat bladder outflow obstruction in men with normally innervated urinary tracts.

Anticholinergic

An anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system.

Antimuscarinic drugs:

An anticholinergic agent that specifically blocks the muscarinic form of the cholinergic receptor. Because they decrease the bladder tone and the amplification of contractions of the urinary bladder and counteract the relaxation of the trigone and external sphincter responsiveness of the bladder wall muscle to stimulating nerve impulses, Antimuscarinic drugs are used in the management of the overactive bladder.

Appendicovesicostomy

Surgical transference of the isolated appendix so that it can be used as a conduit for urinary diversion from the bladder to the skin in children with cloacal exstrophy or neurogenic bladder, making a route for insertion of a catheter.

Areflexic

Absence of reflexes.

Asymptomatic bacteriuria

Significant number of bacteria in the urine that occurs without usual symptoms of infection such as, burning during urination or frequent urination.

Augmentation cystoplasty

Surgical reconstruction of the bladder using an isolated intestinal segment to augment bladder capacity.

Auto augmentation

Surgical procedure in which the detrusor muscle of the bladder is removed, leaving the bladder epithelium otherwise intact.

Autologous fascial sling surgery

A procedure to treat stress urinary incontinence, in which a harvested strip of rectus fascia is used to provide support to the urethra.

Autonomic dysreflexia

Condition associated with damage to the spinal cord above the mid thoracic level characterized by a marked increase in the sympathetic response to minor stimuli such as bladder or rectal distention. It may be triggered by distension of the bladder or colon; catheterization of or irrigation of the bladder; cystoscopy; or during transurethral resection Manifestations include severe hypertension; bradycardia; flushing; and excessive sweating. This is a potentially life threatening condition which should be considered a medical emergency requiring immediate attention.

Autonomic dysregulation

Malfunctioning of the autonomic nervous system (the portion of the nervous system that conveys impulses between the blood vessels, heart, and all the organs in the chest, abdomen, and pelvis and the brain (mainly the medulla, pons and hypothalamus).

Bacteriuria

Presence of bacteria in urine.

Behavioural management programmes

Behavioural therapies are usually used to treat urge urinary incontinence and mixed urinary incontinence. Such therapies include:

Timed voiding where the person is asked to void at set time intervals, rather than in response to a sense of bladder filling.

Bladder retraining where intervals between voids are progressively increased or the patient is asked to delay voiding for a specific time when they experience the need to void.

Habit retraining involves identifying an incontinent person’s toileting pattern and developing an individualized toileting schedule in order to pre-empt episodes of incontinence.

Biofeedback

The process of becoming aware of various physiological functions using instruments that provide information on the activity of those same systems, with a goal of being able to manipulate them at will.

Bladder retraining

See behaviour management programmes.

Bladder stone

Stone found in the urinary bladder formed by crystallization and concretion of salts from the urine usually in stagnate urine, and containing phosphate and oxalate salts of calcium or ammonium. Stones typically form in conjunction with bacterial colonization of the urine, for example when an indwelling catheter is present or bladder emptying is incomplete..

Bricker anastomosis

Technique for performing ureteroenteric anastomosis. This is the joining site of the ureters and the section of intestine used for the diversion for example in an ileal conduit.

Cauda equina compression

serious condition caused by compression of the nerves roots in the lower portion of the spinal canal that supplying the lower limbs and, crucially the bladder and urethral sphincter.

Congenital sacral dysgenesis

A congenital disorder in which there is abnormal foetal development of the sacrum. This can result in major malformation of the lower vertebrae and pelvis, affecting the spinal nerves in the region with resulting neurological impairment.

Crede manoeuvre

Use of manual pressure on a bladder, particularly an acontractile bladder, to express urine.

Cutaneous diversion

Surgical procedure that diverts urine to an abdominal wall stoma. For example a ureterostomy is formed by detaching one or both ureters from the bladder, and bringing them to the surface of the abdomen with the formation of an opening (stoma) to allow passage of urine. An ileal conduit is another form of cutaneous diversion.

Cystectomy

Surgical removal of all or part of the urinary bladder.

Cystometric capacity

Volume of urine that can be held in the bladder.

Detrusor

Detrusor urinae muscle, also detrusor muscle, muscularis propria of the urinary bladder and (less precise) muscularis propria, contracts when urinating to squeeze out urine.

Detrusor overactivity (formerly detrusor hyperreflexia)

Frequently occurring condition characterized by frequency, urgency and urge incontinence. Detrusor overactivity is defined as the presence of involuntary detrusor contractions seen during the filling phase of a urodymnamic study.

Electomyography (EMG)

Technique for evaluating and recording the electrical activity produced by skeletal muscles.[1] EMG is performed using an instrument called an electromyograph, to produce a record called an electromyogram. An electromyograph detects the electrical potential generated by muscle cells[2] when these cells are electrically or neurologically activated. The signals can be analyzed to detect medical abnormalities, activation level, recruitment order or to analyze the biomechanics of human or animal movement.

Epididymo-orchitis

Inflammation of the epididymis and/or testis. It is usually due to infection, most commonly from a urine infection or a sexually transmitted infection.

Febrile UTIs

Urinary tract infections resulting in fever.

Filling cystometry

Part of urodynamic testing in which the bladder is slowly filled with liquid while pressure and volume measurements are taken in order to assess bladder function.

Gore-tex bladder neck sling

Sling made of synthetic material compressing the bladder neck with the aim of preventing stress urinary incontinence

Habit retraining

See behaviour management programmes.

Hydronephrosis

Distension and dilation of the renal pelvis and calyces, usually caused by obstruction of the free flow of urine from the kidney. Untreated, it leads to progressive atrophy of the kidney as a result of back pressure.

Ileal conduit diversion

Surgical technique for the diversion of urine into a specially formed reservoir from a section of the ilieum with a stoma after a patient has had their bladder removed. Urine is transported from the ureters (the tubes draining urine from the kidneys) to a stoma on the abdominal wall using an isolated segment of small intestine.

Ileal loop

An alternative term for ileal conduit.

Ileocecal

A segment of the intestine which comprises part of both the small intestine (ileum) and the large intestine.

Ileocystoplasty

Augmentation cystoplasty using an isolated segment of the ileum for the graft.

Ileum

Final section of the small intestine

Isoperistaltic

Performed or arranged so that the grafted or anastomosed segment of bowel (or other peristaltic tube) exhibit peristalsis that facilitates propogation of material through the bowel segment.

Klebsiella

Frequent human pathogen which can lead to a wide range of disease states, notably pneumonia, urinary tract infections, septicemia, ankylosing spondylitis, and soft tissue infections.

Lipoma of cauda equine

A benign spinal tumour that is predominantly comprised of fat and can cause cauda equina compression or be associated with mal development of the spine and spinal nerves.

Locus of control

Theory in personality psychology referring to the extent to which individuals believe that they can control events which affect them.

Marlex mesh

Used surgically as a reinforcing mesh for example in inguinal hernia repair.

Medullary lipoma

Benign, soft, rubbery, encapsulated spinal cord-tumor, usually composed of mature fat cells.

Meningocele

Type of spina bifida in which the spinal cord develops normally but the meninges protrude from a spinal opening.

Myelitis

Disease involving inflammation of the spinal cord, which disrupts central nervous system functions linking the brain and limbs.

Myelodysplasia

A congenital disorder resulting in a neural tube defect causing defective development of any part of the spinal cord.

Neurogenic

Originating in the nerves or nervous tissue.

Neurogenic bladder

Lower urinary tract dysfunction due to disease of or damage to the nervous system supplying the lower urinary tract.

Neuromusclar electrical stimulation

Procedure used to strengthen healthy muscles or to maintain muscle mass during or following periods of enforced inactivity. This helps to maintain or gain range of motion, to facilitate voluntary motor control, and temporarily reduces spasticity when the nerve supply to the muscle is intact. This procedure involves sending small electrical impulses through the skin to the underlying nerves and muscles to create an involuntary muscle contraction.

Neuropathic

Any pathology of the nervous system.

Neuroradiological

Related to the branch or type of radiology that deals with the nervous system.

Nocturia

Waking from sleep one or more times to urinate.

Non-neurogenic etiology

Originating outside the nerves or nervous tissue.

Overactive bladder:

Produces symptoms of urinary urgency, with or without urge incontinence, usually with an increased frequency of micturition. It is characterised by the presence of involuntary bladder contractions that are seen during bladder filling. These are sometimes termed “bladder spasms”.

Pelvic floor muscle training

Daily training programme to strengthen the muscles that support the uterus, bladder and other pelvic organs and help prevent accidental urine leakage. Also called Kegel exercises or pelvic muscle rehabilitation.

Perineal

Pertaining to the perineum. A region of the body including the genitals and anus.

Pressure-flow studies

Simultaneous measurement of bladder pressure and flow rate during the voiding phase of the micturition cycle. The test is used to assess the process of bladder emptying. For example bladder outflow obstruction can be diagnosed if there is a low urinary flow rate in conjunction with a raised bladder (detrusor) pressure during voiding.

Pelvic Floor Prolapse

Loss of muscle tone and or ligamentous elasticity resulting in the descent of the uterus or other pelvic organs into the vagina. If severe, the prolapse can protrude out of the vaginal orifice.

Prompted voiding

This is used to encourage people to initiate their own toileting. It usually involves positive reinforcement. It involves the use of a carer to take the person with incontinence to the toilet, and so involves education of both the person with incontinence and their carer.

Pseudomonas

Clinically significant and opportunistic pathogen, often causing hospital-acquired infections.

Puboprostatic sling suspension

Support structures, made from natural or synthetic materials, that are implanted so as to support the urethra, to treat urinary stress incontinence.

Pyelonephritis

Ascending urinary tract infection that has reached the pyelum or pelvis of the kidney. It is a form of nephritis that is also referred to as pyelitis.

Pyocystitis

Inflammation involving the accumulation of pus within the urinary bladder. It is typically seen in patients in whom urine has been diverted away from the bladder (for example by an ileal conduit diversion).

Pyuria

Urine which visibly contains pus or microscopically contains an excess of white blood cells.

Qualiveen

A disease specific quality of life measure for individuals with spinal cord injury who have urinary disorders. It has 30 items that focus on four aspects of patients’ lives: bother with limitations, frequency of limitations, fears, and feelings. Response options are framed as five-point scales with 0 indicating no effect of urinary problems on health-related quality of life and four indicating a high adverse effect

Rectus fascia

Connective tissue that surrounds, the paired muscle running vertically on each side of the anterior wall and all the blood vessels, and nerves, binding those structures together.

Rectus sheath

Consists of two lamina, the anterior sheath and the posterior sheath. The sheath is made up of the aponeuroses of the three anterolateral abdominal muscles as they converge at the linea alba. The makeup of the anterior and posterior sheaths vary depending on the level of the abdominal wall examined.

Renal calculi

Stones in the kidney, usually formed in the urine-collecting area of the kidney (kidney pelvis). Their sizes vary and most contain calcium oxalate.

Sacral agenesis

A condition that exists when either part or all of the sacrum is absent. It is usually associated with impaired development of sacral spinal nerves and with consequent pelvic organ and lower limb dysfunction.

Sacral teratoma (Sacrococcygeal teratoma)

Tumour occuring in the sacrococcygeal region, usually noted at birth or appearing soon after.

Renal Scintigraphy

photographic recording, with the use of a gamma camera, of the distribution of a radioisotope (radioactive substance) given by injection which accumulates in the kidneys and allows the production of pictures offering details on both kidney structure and function.

SF-36

A multi-purpose, short-form health survey with only 36 questions. It yields an eight-scale profile of functional health and well-being scores as well as psychometrically-based physical and mental health summary measures and a preference-based health utility index.

Sigmoid

Segment of the colon between the descending colon and the rectum.

Spina bifida

A condition in which the bones of the spine do not close. In cases of myelomeningocoele, the bony abnormality is accompanied by abnormal development of the spinal cord or nerves and their covering membranes, which leads to abnormalities in the nerve supply to the lower limbs and pelvic organs.

Spinal cord lipoma

Fatty non-cancerous tumour within or around the spinal cord without any skin or bony abnormalities. Most commonly these lesions are located within the thoracic spinal cord and may cause symptoms of spinal cord compression. They appear most often in adults.

Spinal dysraphism

A general term that encompasses a number of different developmental abnormalities of the spine and spinal cord, of which spina bifida is an example.

Stomal stenosis

Narrowing of the stoma.

Timed voiding

See behavioural management programmes.

Transverse colon

The part of the large intestine that runs from the ascending colon, across the abdomen, to continue as the descending colon.

Transverse myelitis

Neurological disorder caused by inflammation within a localised section of the spinal cord. Damage and scarring can occur affecting the function of the nerve connections crossing that segment

Ureteroileal stenosis

Narrowing of the tubes that carry urine from the kidneys at the point where they are joined to an ileal conduit.

Urethral

Related to the canal through which urine is discharged from the bladder

Urethral tape and sling surgery

A procedure that restores bladder control for people who lose urine when they cough or exercise. The urethral tape procedure involves positioning an artificial tape under the urethra, which is the tube that runs from the bladder through which you urinate. The tape will then rest like a hammock under the urethra, giving support and maintaining continence. A urethral tape consists of a thin mesh ribbon that is placed in order to provide support to the urethra. Urethral sling surgery involves placing a sling around the urethra to lift it back into a normal position and to exert pressure on the urethra to aid urine retention. The sling is attached to the abdominal wall. Also, please see: Autologous fascial sling surgery.

Urge incontinence

See overactive bladder.

Urinary diversion

Surgical procedure to reroutes urine flow from its normal pathway either temporarily or permanently.

Urodynamic investigations:

Investigation of the function of the lower urinary tract (the bladder and urethra) using physical measurements such as urine pressure and flow rate, as well as clinical assessment. Video-urodynamic investigations involve using a dye to fill the bladder enabling X-rays of the lower urinary tract to be taken during filling and emptying of the bladder.

Stress incontinence

Stress urinary incontinence describes a symptom, a sign and a diagnosis, although it is only following urodynamic investigation that a diagnosis of urodynamic stress incontinence can be made. This condition is defined as ‘the involuntary leakage of urine during increased abdominal pressure in the absence of a detrusor contraction’.

Uroflowmetry

Diagnostic test used to measure the flow of urine during urination.

Urosepsis

A systemic inflammatory response to urinary tract infection which may result in septicaemia, multi-organ failure and death if severe. The term is used occasionally used to mean any urinary tract infection.

Vesicoureteral reflux

Retrograde flow of urine from the urinary bladder up the ureter. This is may be due to a congenital abnormality of the vesicoureteral valve, recurrent infection or raised intravesicular pressure as a result of bladder outlet obstruction or neuropathic bladder sphincter dyssynergy.

Vesicovaginal fistula

Abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault.

Visual analogue scale

Psychometric response scale which can be used in questionnaires. It is a measurement instrument for subjective characteristics or attitudes that cannot be directly measured.

Copyright © 2012, National Clinical Guideline Centre.

Apart from any fair dealing for the purposes of research or private study, criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, no part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency in the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page.

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Bookshelf ID: NBK132850

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