What is iatrogenic voiding dysfunction?

Updated: Aug 08, 2019
  • Author: Frances M Dyro, MD; Chief Editor: Robert A Egan, MD  more...
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Answer

Whereas a painless atonic neurogenic or motor paralytic bladder can be caused by peripheral neuropathy of diabetes or alcoholism, it can also be the result of trauma or pelvic surgery. In rare cases, pudendal nerves are injured after orthopedic surgery for femoral fractures. Amarenco et al reported 6 cases of pudendal nerve traction after orthopedic surgery in which bladder function was not involved, but the patients did experience genital sensory deficit and erectile dysfunction. [37]

A flaccid, unresponsive bladder can be seen in patients who are overmedicated with tricyclic antidepressants or antiparkinson medications or who have electrolyte imbalances.

Tricyclic antidepressants have anticholinergic properties and tend to decrease detrusor contractility. This property of drugs such as imipramine and amitriptyline has led to their being frequently used for the treatment of detrusor instability. When used in higher dose ranges or in patients with previously asymptomatic outlet obstruction, they may produce urinary retention.

The calcium channel blockers used in migraine or cardiovascular disorders also may produce urinary retention by decreasing bladder contractility. Some beta-adrenergic blockers can increase urethral pressure. Propranolol has been used therapeutically for this reason; however, in a hypertensive patient with prostatic enlargement, it may produce an unwanted increase in outlet resistance.

Pseudoephedrine and phenylpropanolamine (recalled from the US market), which are found in cough remedies, have a similar tendency to increase outlet resistance and may cause a man with benign prostatic hypertrophy (BPH) to retain urine. Alpha-blockers have been used to decrease outlet resistance in patients with BPH but may aggravate stress incontinence.

Donepezil, an anticholinesterase that is highly selective for the central nervous system, has been used for the treatment of cognitive impairment in patients with Alzheimer disease. Hashimoto et al have reported a 7% incidence of urinary incontinence in previously continent patients treated with donepezil. [38]

Galantamine also has incontinence and frequency as potential adverse effects. This is a concern because urinary incontinence in patients with dementia has a considerable effect on potential placement.

Concerns have been raised about using anticholinergic medications for detrusor overactivity and potentially worsening dementia in patients with mild cognitive dysfunction. [39, 40]

Incontinence or frequency of urination may be seen as a complication of pelvic irradiation. Radiation cystitis may be present during the course of the radiation or may appear as a late effect.


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