Referat

WOMANS LOWER URINARY TRACT

SYMPTOMS (LUTS)

Janeva Septiana Sihombing

Supervisor: dr. H. Marta Hendry, SpU

Lower Urinary Tract consist of

Introduction

Urinary Tract anatomy

Production, storage and avoid

the urine

Consist of renal, ureter, vesica

urinaria and uretra.

Renal: filtration

Ureter: voiding urine from

pielum to vesica urinaria.
Ureter wall consist of
trantitional cell mocous,
circular smooth muscle and
longitudinal smooth muscle.

Lower Urinary Tract

anatomy

Vesica urinaria: 3 layers of

detrussor muscle;
longitudinal muscle, circular
muscle, and longitudinal
muscle.

Mucosa of vesica : trantitional

cell

Trigonum area atau

Trigonum buli-buli

Uretra: Sphincter uretra

interna (smooth muscle)

Woman: uretra 3-5 cm

Micturition
MicturitionProcess
Process

Lower Urinary Tract

Symptoms
Consist of:
Storage/iritation symptoms
Voiding/obstruction symptoms
Post-micturition Symptoms

Patofisiology

LUTS

LUTD

Pathofisiology
Storage dysfunction

Bladder overactivity (involuntary contraction or

decreased compliance) and decreased outlet
resistance may cause absolute or relative
failure of the bladder to store urine adequately.

Pathofisiology
Storage dysfunction

Pathofisiology
Storage dysfunction

1.
.

Overactivity Bladder
Alterations in nerve and smooth muscle
excitability and changes in bladder urothelium
composed of neurotransmitters, sensory receptors,
and specific ion channels.

. Bladder-related

storage failure may also occur in the

absence of overactivity because of increased
afferent input from inflammation, irritation, other
causes of hypersensitivity, and pain. The causes may
be chemical, psychologic, or idiopathic

Pathofisiology
Storage dysfunction

2. Bladder Outlet Underactivity

urethra supported by the action of the levator
ani muscles through their connection to the
endopelvic fascia of the anterior vaginal wall.

Damage to the connection between this fascia and this

muscle, damage to the nerve supply, or direct
muscle damage can therefore influence continence.

Pathofisiology
Emptying/Voiding Dysfunction

Absolute or relative failure to empty

the bladder results from decreased
bladder contractility (a decrease in
magnitude or duration), increased
outlet resistance, or a combination.

Emptying/Voiding Dysfunction
1.

Detrusor Underactivity

failure of bladder contractility may result from failure or

impairment in one of the neuromuscular mechanisms for
initiating and maintaining a normal detrusor contraction.
Inhibition of the voiding reflex in a neurologically; it may be
by a reflex mechanism secondary to increased afferent
input, especially from the pelvic and perineal areas, or
may be psychogenic

 Non-neurogenic

causes also include

impairment of bladder smooth muscle
function, which may result from
overdistention, various centrally or
peripherally
acting
drugs,
severe
infection, or fibrosis.

Emptying/Voiding Dysfunction
2. Bladder Outlet Overactivity or Obstruction
failure of relaxation or active contraction of the striated
or smooth sphincter during bladder contraction.
Striated sphincter dyssynergia is other common cause of
functional or nonanatomic (as opposed to fixed anatomic)
obstruction in patients with neurologic disease or injury.
A common cause of outlet obstruction in the female is
compression or fibrosis following surgery for sphincteric
incontinence

Pathofisiology

Postvoid dribbling: involuntary leakage of

urine immediately after voiding.
Vesicovaginal reflux whereby urine is
trapped in the vagina during voiding, and
once stands the urine begins to dribble out.

In women, incomplete emptying was more

common.

Risk Factor

Age

Diagnostic Measure
Anamnesis

Diagnostic Measure
Neurogical

Diagnostic Measure
Post-voiding residual volume

Diagnostic Measure
UrethrocystUrography

Management
Behavioural

Thank You