Editing Functional: Pathophysiology and Classification of LUT Dysfunction (section)

=== Failure to Empty ===

* '''<span style="color:#ff0000">Results from (or a combination of) (2):</span>'''
*# '''<span style="color:#ff0000">Bladder underactivity (a decrease in magnitude, coordination, or duration)</span>'''
*# '''<span style="color:#ff0000">Increased outlet resistance</span>'''
*'''Poor emptying from detrusor underactivity or detrusor areflexia (causing overflow incontinence) might also cause urinary incontinence.''' 
**'''This type of detrusor dysfunction is common with neurologic diseases affecting the lumbosacral cord or conus medullaris.'''
*'''Systemic diseases, which can result in peripheral neuropathies such as diabetes, tabes dorsalis, and alcoholism, can similarly cause overflow incontinence.'''
*'''Radical pelvic surgeries (i.e., radical hysterectomy, abdominoperineal resection) can also result in significant, sometime permanent, neurogenic detrusor dysfunction leading to urinary retention and overflow incontinence.'''
* '''Other processes such as traumatic cervical or upper thoracic spinal cord injury can cause detrusor sphincter dyssynergia, creating impaired bladder emptying and UI, particularly when coupled with neurogenic detrusor overactivity'''.

==== Bladder Underactivity ====

* May result from temporary or permanent failure or impairment in one of the neuromuscular mechanisms necessary for initiating and maintaining a normal detrusor contraction.
* '''<span style="color:#ff0000">Causes:</span>'''
** '''<span style="color:#ff0000">Neurologic diseases affecting the lumbosacral cord or conus medullaris.</span>'''
** '''<span style="color:#ff0000">Systemic diseases, which can result in peripheral neuropathies such as diabetes, tabes dorsalis, and alcoholism</span>'''
*** Whereas early in the disease process diabetes can lead to UUI, later in the process sensation can be altered as can detrusor contractility, resulting in impaired bladder emptying, UTIs, and UI.
** '''<span style="color:#ff0000">Radical pelvic surgeries''' (i.e., radical hysterectomy, abdominoperineal resection)</span>

==== Increased Outlet Resistance ====

* Much more common in men than in women
* Most often secondary to anatomic obstruction; may be secondary to a failure of relaxation or active contraction of the striated or smooth sphincter during bladder contraction

==== Management ====

* '''<span style="color:#ff0000">Directed towards:</span>'''
*# '''<span style="color:#ff0000">Increasing intravesical/detrusor pressure</span>'''
*# '''<span style="color:#ff0000">Facilitating the micturition reflex</span>'''
*# '''<span style="color:#ff0000">Decreasing outlet resistance</span>'''
*# '''<span style="color:#ff0000">Combination of the above</span>'''
*# '''<span style="color:#ff0000">If other means fail or are impractical, intermittent (or continuous) catheterization is an effective way to circumvent emptying failure.</span>'''