Overdistension Of Urinary Bladder Research Articles

Fatal cerebral hemorrhage in a tetraplegic patient due to autonomic dysreflexia triggered by delay in emptying urinary bladder after unsuccessful intermittent catheterization by carer: lessons learned

IntroductionOver-distension of urinary bladder in a high spinal cord injury patient is a triggering factor for autonomic dysreflexia. Removing triggering factors is vital to prevent autonomic dysreflexia.Case presentationA 36-year-old tetraplegic patient, who was managed by intermittent catheterizations performed by caregivers, developed recurrent autonomic dysreflexia during a week due to: 1) carers not performing intermittent catheterizations every night; 2) infrequent catheterizations during the day, leading to distension of urinary bladder. A day before his demise, carer attempted routine catheterization; but was unable to insert the catheter; blood pressure rose to 192/109 mmHg. Nifedipine 10 mg was administered. Thirty minutes later, blood pressure was 181/113 mmHg; second dose of Nifedipine was not given. Forty minutes elapsed before a senior carer came and catheterized successfully. Meanwhile, patient developed pounding headache; became drowsy; was talking incoherently. Four and half hours after unsuccessful catheterization, carers contacted emergency services and the patient was taken to Accident and Emergency; CT of head revealed very large acute intracranial hemorrhage in the right frontal and parietal lobes. The patient expired a day later. The Coroner’s verdict: “Patient died of massive intracranial hemorrhage caused by autonomic dysreflexia, a known complication of high spinal cord injury. Emergency protocols to manage autonomic dysreflexia were not followed in the days leading up to his death.”ConclusionFailed urethral catheterization is a potentially life-threatening emergency; every patient should have a care plan explicitly describing what should be done when catheterization is not successful. Preventive measures rather than episodic treatment of autonomic dysreflexia should be the guiding principle.

Negativism Associated Urinary Bladder Overdistension: a Case Report

Negativism is known as resistance to instructions, contrary comportment to what asked. Negativism is mostly associated with catatonia. Genitourinary complications like urinary retention or urinary incontinence or infections can be seen in catatonia. Here we describe a case of negativism associated urinary bladder overdistension without catatonia. We aim to call attention that urinary bladder overdistension may be associated with negativism without catatonia. A 37 years old female patient had a history of psychotic depression for seven years. She had been on olanzapine treatment during last year until she learnt that she was pregnant six weeks ago. In the past ten days, the patient has not talked, eaten, drunk or slept so she was hospitalized in psychiatry inpatient clinic. Abdominal ultrasound revealed that her bladder volume was nearly 1500 cc and compressing on uterus. A urinary catheter was placed and urinary bladder overdistension resolved. After seven sessions of Electroconvulsive therapy (ECT), she recovered completely. Pulmonary complications like pulmonary embolism, pneumonia and aspiration; gastrointestinal complications like constipation due to decreased food intake and dehydration; dental complications due to decreased oral hygiene; genitourinary complications like urinary retention or urinary incontinence or infections; flexion contractures, postural nerve palsies and rhabdomyolysis due to immobilization can be seen in catatonia. Urinary bladder overdistension was associated with catatonia in literature but in our case urinary bladder overdistension was associated with negativism without full criteria of catatonia. Caution should be given to negativist pregnant woman because urinary bladder overdistension could be concealed by pregnancy.

The changes of function and ultrastructure of detrusor cell following acute urinary bladder overdistension

Objective To evaluate the contractive function and ultrastructure changes of detrusor following acute bladder overdistension.Methods 14 New Zealand white male rabbits were divided into two group,7 rabbits in each.Overdistension group was induced for 3 hours by forced diuresis and ligation of urethra to volumes 130％ of maximum intravesical volume.control group was catheterized with an 8 F catheter but not instillation.The weight of each bladder and function and ultrastructure of detrusor were examined after3 d.Results The weight of bladder is (3.45±0.36) gin overdistension group and (4.02±0.47) g in control group.The contractive strength of per 100 mg detrusor of overdistension group increased significantly in adenosine-triphosphate (ATP) solution,atropine solution and Ca2+ free solution; The contractive velocity increased significantly.in atropine solution,Ca2+ free solution and high K + solusion; The average area of rough endoplactmic reticulum in overdistension group was (1.748 ± 0.772) μm2 in each unit cytoplasm area versus (0.203 ± 0.097) μm2 in control group (P ＜ 0.05).The relative density of mitochondrion was 1.142 ± 0.085 in overdistension group versus 1.681 ± 0.219 in control group (P ＜ 0.05).Conclusion Overdistension of bladder will increase the constructive function of detrusor.and there are structure foundations of the changes. Key words: Bladder; Overdistension ; Endoplactmic reticulum ; Mitochondrion

Cardiovascular manifestations of perioperative acute urinary bladder over-distension.

Cardiovascular manifestations of perioperative acute urinary bladder over-distension.

Effects of Acute Urinary Bladder Overdistension on Bladder Response during Sacral Neurostimulation

Objective: Urinary retention and micturition disorders after overdistension are clinically well-known complications of subvesical obstruction. We attempted to evaluate whether bladder overdistension influences bladder response and whether overdistension supports detrusor decompensation. Methods: Following lumbal laminectomy in 9 male foxhounds, the sacral anterior roots S2 and S3 were placed into a modified Brindley electrode for reproducible and controlled detrusor activation. The bladder was filled in stages of 50 ml from 0 to 700 ml, corresponding to an overdistension. At each volume, the bladder response during sacral anterior root stimulation was registered. After overdistension, the bladder was refilled stepwise from 0 to 300 ml and stimulated. Results: In all dogs, the bladder response was influenced by the intravesical volume. The maximum pressure (mean 69.1 cm H₂O) was observed at mean volume of 100 ml. During overdistension, a significant reduction in bladder response of more than 80% was seen. After overdistension, a significant reduction in intravesical pressure of 19.0% was observed. In 2 cases, reduction in bladder response was more than 50% after a single overdistension. Conclusions: We conclude that motoric bladder function is influenced during and after overdistension. A single bladder overdistension can support acute and long-lasting detrusor decompensation. In order to protect motoric bladder function, bladder overdistension must be prevented.