All defects in functional urinary transport lead to urinary ectasia, with consequent development of progressive hydronephrosis and loss of renal function.
They are generally characterised by pain in the lumbar region, gastrointestinal symptoms, shivering, fever, dysuria, weight loss and uremic syndrome.
- Vesicoureteral reflux: This causes the urine to return from the bladder back the upper ureters, due to defects in the mechanism of the vesicoureteral sphincter.
This causes repeated urinary infections with pain radiating to the hypogastric and lumbar regions after urination.
It develops into progressive pielonephritis, with arterial hypertension and symptoms of kidney failure.
Patients should get into the habit of urinating frequently, every two hours without pressure or with a temporal vesicular catheter, so long as there is no upper urinary ecstasia. If this is the case, surgery is indicated.
- Abnormal emptying of the bladder: This is due to stricture of the bladder outlet due to prostate ademona or sclerosis of the outlet, or to defective urine flow caused by uretral stenosis or vesicular lithiasis, or because of the reduced contractile capacity of the detrusor in hypotonia and dilation of the bladder.
This produces serious post-urination residue, which leads to a risk of infection if it occurs repeatedly.
Hypotonia of the bladder can cause an authentic vesicular globe with functional urethral stenosis and the development of hydronephrosis.
Treatment is based on removing the obstacle by surgical means, and treating the bladder hypotonia using a variety of techniques, with varying degrees of success.
- Urinary incontinence: Involuntary urination is caused by poor synchronization of intravesicular pressure and the sealing mechanism.
During episodes of cystitis or when there are tumours in the bladder, the patient often has an urgent need to urinate. This often happens after accidents or operations when defects in the sealing mechanism can arise, as well as pelvic floor failure and neurological disorders.
The treatment is that indicated for infections and tumours.
Irritable bladder and hypertonic bladders are not easy to treat, and require medication with tonic or sedative medication.
Surgery may be indicated out when the pelvic floor drops.
Advice on Vesicoureteral reflux
- The patient should only drive short distances.
- If driving cannot be avoided the patient should make frequent stops to avoid dangerous urinary retention.
- When there are infectious complications, the patient must not drive until the clinical symptoms have completely disappeared and the doctor should warn the patient about this.
- Kidney failure precludes the patient from driving because of poorly-controlled hypertension.
Advice on Abnormal emptying of the bladder
- Patients with vesicular globe must not drive. Any knocks or sudden pressure from the seat belt in a crash can rupture the bladder.
- Driving is not possible if the patient is suffering from an associated urinary infection, until the treatment has caused the symptoms to disappear.
- It is often necessary to stop to urinate, meaning the patient is able to drive freely when there are no necessary facilities available to the driver on the public highways.
- Problems with sleeping at night due to the need to get up repeatedly to empty the bladder can mean the patient is tired and at greater risk of losing control of the vehicle while driving.
- Kidney failure precludes the patient from driving because of poorly-controlled hypertension and the uremic symptoms.
Advice on Urinary incontinence
- The urgent need to urinate limits driving to a great extent, as the patient needs to stop the car frequently. This inconvenient situation causes nervousness and is risky if the patient cannot easily find somewhere to empty his bladder.
- While the patient is being treated for infections and is symptomatic, driving is not permitted.
- The surgical treatment of bladder tumours, which is occasionally associated with intravesicular chemotherapeutic lavage, means the patient may not drive until the doctor has informed him that he has recovered without symptoms or sequelae which cause disability.
- The patient must be warned of the side effects of medications, which can affect driving, such as some analgesics, spasmolytics and sedatives.