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Uroflowmetry

Urinary disorders can often indicate a lot of underlying complications. Urination and the excreted product is very significant in evaluating a person's health in associated with kidney function and prostrate health in case of men. Urination is a complex procedure, which involves the contraction of the muscles associated with the detrusor and the external bladder tissues. The cerebral cortex facilitates the initiation and emptying of the bladder during the urination process.


Urination can be affected for various reasons such as weather, emotions, and hormonal imbalance, incontinence due to anatomical disorders and also underlying inflammations or infections. The regulation of blood pressure and adrenal surge is also involved in proper generation of urine. Physicians analyze the uroflowmetry parameters in order to diagnose urinary tract infections and also to evaluate the normal flow rate of urine to determine the normal function of the urinary tract and associated muscles.


Uroflowmetry is widely recommended in many countries, as it has become the foundation for diagnosing prostrate enlargement, urethritis and obstruction. Males over 30 years are advised to undergo this test as it is necessary to detect the early signs of an underlying condition such as prostate cancer, bladder tumor or neurogenic bladder dysfunction where the cause is spinal cord injury or lesion. Typical conditions where uroflowmetry might be advised are difficulty in urinating, frequency of urination, nocturia, enuresis, Benign Prostatic Hyperplasia, urethral stenosis or incomplete bladder emptying.


Preparation and procedure

Patients undergoing uroflowmetry procedure are advised to drink plenty of water in order to fill up the bladder as it provides a comprehensive analysis of the bladder functionality. They are also asked to hold the urine for a few hours before the test. Unlike other urinary examinations, here the specimen is not collected in a cup but the patient is asked to urinate into a funnel that connects to a container underneath. Special toilets are provided in some diagnostic centers for this procedure. The funnel shaped device measures the urine flow rate and quantity and the results obtained are recorded.


The normal flow rate of the urine varies from 10 ml to 20 ml per second. The results associated may vary both in males and females. The flow rate in women is often less as it may take 15 ml to 18 ml per second. In men, urine flow declines with age. Women have lesser change with age.

14 - 45 years

The average flow rate for males is 21 ml/sec.
The average flow rate for females is 18 ml/sec.

46 - 65 years

The average flow rate for males is 12 ml/sec.
The average flow rate for females is 18 ml/sec.

66 - 80 years

The average flow rate for males is 9 ml/sec.
The average flow rate for females is 18 ml/sec.


The diagnostic evaluations based on this can indicate the strength of the bladder muscles and also other disorders. Delayed urine flow indicates obstruction and also infections that are causing tissue inflammation. Increased flow of urine also indicates weak bladder muscles and also lack of cerebral cortex control. Incontinence is widely reported in elderly groups. Neurological conditions and trauma can also affect urine flow rate.


Multiple System Atrophy

Multiple system atrophy (MSA) is an alarming neurological disease that can cause adverse effects on the body. The primary targets for this condition are the involuntary muscles. MSA is a rare form of neurological disorder. It damages the control and co-ordination of muscle related physiology. This degenerative disease has no underlying etiology. The damage is predominantly in the striatonigral and olivopontocerebellar regions of the brain.


This disease was also known as Shy Drager syndrome. Due to its association with Parkinsons-like symptoms and also partly with amyotrophic lateral sclerosis (ALS), it has been categorized as Multiple System Atrophy to specify the symptoms. This has enabled medical centers to evaluate and diagnose the disorder in an effective manner. Studies indicate that the populations that are affected by the MSA are often elderly groups.


Classification and clinical manifestations

Multiple system atrophy is classified into two types for definitive diagnosis during the evaluation of the patient based on the symptoms.

The Parkinsonian category: In this form of MSA, the symptoms associated are very closely related to the Parkinson's pattern. It is also called MSA-P. Muscle rigidity is observed along with slow movements of the muscles, which are also referred to as Bradykinesia. Muscle cell degeneration predominantly occurs in the striatonigral region leading to tremors, lack of balance and postural impairment.

Cerebellar category: This form of MSA is called MSA-C, which is associated with the ataxia of cerebellar region. Loss of balance and prominent gait are the noticeable symptoms. The onset of dysarthria affects the vocal muscles and the patient's voice slows down and sometimes becomes inaudible. This is followed by difficulty in swallowing as the muscles lose their control sustenance from the cerebral region. In addition to this, blurred vision and dizziness have been reported in MSA-C.


Other associated symptoms of Multiple System Atrophy are urinary incontinence, orthostatic hypotension, erectile dysfunction, urinary retention, constipation and uncontrolled bowel movements. Patients experience light-headedness, dizziness and also low blood pressure because of the slow responses associated with the autonomic nervous system. The reflex arc and its respective functions are also impaired especially in Parkinsonian category.

Autonomic function tests are done to detect the onset of MSA-P and MSA-C at an earlier stage. Research affirms that although MSA is a rare form of neurological disorders, the occurrence in elderly people is slowly increasing. This is because of the lifestyle patterns and also underlying medical conditions such as diabetic neuropathy and Alzheimer's. Statistics indicate that the MSA occurs in 4 in every 100,000 people.


In most cases, diagnosis is done through a complete study of the muscle physiology and skeletal muscle responses after a certain age. In males, prostrate related carcinomas and myelomas can also aggregate this disorder in a larger way as it deteriorates the muscle tissue causing abnormal rise of non-functional proteins in the body.


Diagnosis and Treatment

MSA is diagnosed by evaluating the history of the patient and through physical examination. Tests such as muscle extension, flexion, and response to stimuli, vocal tone strength and posture are done to evaluate the muscle dexterity and functionality. Laboratory diagnosis of blood samples are done to evaluate liver and kidney function tests. In men prostrate examination is also done to study the urological coherence to the respective disease. Urology tests such as uroflowmetry and urinary control is investigated to study the extent of atomic nervous system and cerebellar functionality. Cardiac evaluations are performed to study hypotension and arrhythmia associated with it. Radiological examinations such as CT, PET and MRI are done to understand the involvement of central nervous control damage.


Therapeutic treatments are most often used with MSA. In many cases physical, occupational and speech therapies are done to increase the muscle movements and response of the patient. For Parkinsonian related MSA, L-Dopa, amantadines are administered for better results. Other drugs include Fludrocortisone, Midodrine, Oxybutinin, and Trospium chloride and botulinum toxin incase of dystonia.



Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia or BPH, also referred to as prostate gland enlargement is one of the most significant medical conditions among elderly men. It is a serious condition which proactively leads to other complications such as urinary tract infections and prostate gland functional abnormalities. The prostate gland is a two-lobed walnut shaped gland often associated with sperm mobilization. The growth of the prostate gland is directly related to age. The exact mechanism or the cause of this condition is not well determined. However, many studies indicate that the hormonal imbalance as the age increases in a man is responsible for the enlargement of the prostate gland. This refers to the excessive production of estrogen and decrease in the male sex hormone testosterone.


Clinical manifestations of BPH

The symptoms of Benign Prostatic Hyperplasia (BPH) worsen with age. The most common clinical symptom is repeated urination episodes. Often patients either complain of frequent urination, urinary urge or even difficulty in passing urine if there is an associated infection. These symptoms occur because of the inability of the tissues to make space for the enlarged or hypertrophic prostate gland. This lays pressure on the urethra to stimulate the process of urination frequently. Many patients complain of Nocturia. In addition to these symptoms, patients also suffer renal stones and reduced kidney function.


Diagnosis and Management of Benign Prostatic Hyperplasia

BPH is diagnosed based on various urological criteria. The American Urological Association recommends a score system. In most cases patients are examined to identify the presence of malignancy in the prostate region and hence test such as prostate specific antigen (PSA) is recommended along with cytological study of the prostate gland. Important parameters such as post-void residual volume, uroflowmetry, urinary pressure studies are conducted. Along with these diagnostic parameters, kidney function test is done to rule out other associated complications.

BPH can also transmit as a genetic disorder in some cases. The high risk groups are generally obese or suffer diabetes and hypertension. Along with these, other factors such as alcoholism, drug abuse and erectile dysfunction can lead to BPH.


Treatment of Benign Prostatic Hyperplasia

BPH patients are often kept under surveillance to avoid medical emergencies. The drugs administered for this condition reduce blood pressure and facilitate smooth muscle relaxation of the prostate gland thereby regulating urine flow. The drugs used are predominantly alpha blockers such as alfuzosin, terazosin and anticholinergics.

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Collection of Pages - Last revised Date: December 11, 2017