Full Description
The anticipation of seeing and having to manage patients suffering from sensory disorders of the urinary tract brings dismay and foreboding to the urologist. This stems from his experience of the time that these patients take up, both at the stage of initial interview and subsequently during numerous consultations over periods of months and years. This and the largely unsatisfactory response to various forms of therapy in the past are reason enough for this bold attempt to define with objectivity the notoriously subjective disorders of interstitial cystitis, urethral syndrome and prostatodynia. In writing this book the principal aim of the authors has been to define these three entities concisely and to describe the investiga- tional methods which are required to establish the diagnosis in each case. The importance of this cannot be overestimated since, when the label of one or other of these conditions is attached to a patient, further objective consideration of the case is-endangered.
The casual attribution of these sensory diagnoses to inappropriate cases is already on record as having dulled clinical awareness and led to oversight of progressive disease and its sometimes avoidable conse- quences.
Contents
Section 1 Basic Considerations.- 1 Introduction and Definitions.- Difficulties in Definition.- The Hypersensitive Disorders of Micturition.- 2 Normal Sensation of the Lower Urinary Tract.- Description of Normal Sensation.- Anatomical and Physiological Considerations.- 3 Diagnostic Criteria of the Hypersensitive Disorders.- Sensation in the Hypersensitive Disorders.- Bacteriological Considerations in the Diagnosis of the Hypersensitive Disorders.- The Hypersensitive Disorders and Detrusor Contraction.- Conclusion.- 4 Examination and Investigation of Sensory Patients.- Cystometric Examination.- Electromyography.- Assessment of Anxiety.- Frequency/Volume Charts.- Assessment of Bladder and Urethral Sensation.- Microbiological Considerations.- Examination Under Anaesthetic.- Section 2 Interstitial Cystitis.- 5 Historical Perspective.- 6 Clinical Symptom Complex.- Techniques of Investigation.- Concluding Remarks-Value of Diagnostic Methods.- 7 Morphological Studies of the Bladder Wall in Interstitial Cystitis.- General Pathology.- Specific Pathology.- 8 Treatment of Interstitial Cystitis.- Treatment.- Summary.- Section 3 The Urethral Syndrome.- 9 Historical Review-Confusions in Definition.- 10 Microbiology of the Female Urethra and Adjacent Areas.- Microbiology of the Female Lower Genito-urinary Tract.- The Role of Potential Bladder Pathogens in the Urethral Syndrome.- The Role of Sexually Transmitted Organisms in the Urethral Syndrome.- Conclusions.- 11 Urethral Syndrome-Clinical Features.- Definition of Urethral Syndrome.- Incidence.- History.- Urethral Hypersensitivity and Allied Conditions.- Examination and Routine Investigation.- The Urge Syndrome.- 12 Structure of the Trigone and Urethra in the Urethral Syndrome.- Pseudo-membranous Trigonitis.- Urethral Morphology.- 13 Urethral Syndrome-Urodynamic Studies.- Urodynamic Observations.- 14 Treatment of the Urethral Syndrome.- General Measures.- Antibiotics.- Pharmacological and Surgical Treatment for the Urethral Syndrome.- Alternative Surgical Techniques.- Bladder Retraining.- Section 4 Prostatodynia.- 15 Inflammatory Prostatic Disease.- Investigation of the Patient.- Diagnostic Significance of Expressed Prostatic Secretion.- General Examination and Investigation of the Prostatitis Patient.- Aetiology of Prostatitis.- Aetiology of Non-bacterial Prostatitis.- Management of Patients with Prostatitis.- The Urinary Tract Infection Clinic.- 16 Prostatodynia-Clinical Aspects.- Aetiology of Prostatodynia.- Clinical Features.- The Anxious Bladder.- Examination and Investigation.- 17 Prostatodynia and Anxious Bladder-Urodynamic Aspects.- Urodynamic Observations.- Interpretation of Urodynamic Observations in Psychogenic Voiding Disorders.- Low Pressure/Low Flow Micturition and Detrusor-Sphincter Dyssynergia.- 18 Application of Psychological and Psychophysiological Methods in Prostatodynia.- Procedure.- Results.- Discussion.- 19 Treatment of Prostatodynia and the Psychogenic Voiding Disorders.- Non-specific Methods of Treatment.- Operative Treatment of Voiding Abnormalities.- Pharmacological Relaxation Therapy.- Summary.
