Appendix B: Glossary

Alpha-blocking agents

Drugs that inhibit the response to sympathetic impulses by blocking the alpha receptor sites of effector organs. Because they inhibit the contraction of non-vascular smooth muscle such as that found at the bladder neck and within the prostate, alpha-blockers are commonly used to treat bladder outflow obstruction in men with normally innervated urinary tracts. Also known as 'alpha adrenergic blocking agents' or 'alpha adrenergic antagonists'.

Antimuscarinic drugs

An anticholinergic agent that specifically blocks the muscarinic form of the cholinergic receptor. Because they decrease the responsiveness of the bladder wall muscle to stimulating nerve impulses, antimuscarinic drugs are used in the management of the overactive bladder.

Augmentation cystoplasty

Surgical reconstruction of the bladder using an isolated intestinal segment to augment bladder capacity.

Autologous fascial sling surgery

A procedure to treat stress urinary incontinence, in which a harvested strip of rectus fascia is used to provide support to the urethra. Also see urethral tape and sling surgery.

Behavioural management programmes

Behavioural therapies are usually used to treat urge urinary incontinence and mixed urinary incontinence. Such therapies include:

  • Timed voiding where the person is asked to void at set time intervals, rather than in response to a sense of bladder filling.

  • Bladder retraining where intervals between voids are progressively increased or the patient is asked to delay voiding for a specific time when they experience the need to void.

  • Habit retraining involves identifying an incontinent person's toileting pattern and developing an individualised toileting schedule in order to pre-empt episodes of incontinence.

Biofeedback

The process of becoming aware of various physiological functions using instruments that provide information on the activity of those same systems, with a goal of being able to manipulate them at will.

Bladder retraining

See behavioural management programmes.

Bladder stone

Stone found in the urinary bladder formed by crystallisation and concretion of salts from the urine and containing phosphate and oxalate salts of calcium or ammonium. Stones typically form in conjunction with bacterial colonisation of the urine, for example, when an indwelling catheter is present or bladder emptying is incomplete.

Cauda equina compression

A serious condition caused by compression of the nerve roots in the lower portion of the spinal canal that supply the lower limbs and the bladder and urethral sphincter.

Cystectomy

Surgical removal of all or part of the urinary bladder.

Filling cystometry

Part of urodynamic testing in which the bladder is slowly filled with liquid while pressure and volume measurements are taken in order to assess bladder function.

Habit retraining

See behavioural management programmes.

Hydronephrosis

Distension and dilation of the renal pelvis and calyces, usually caused by obstruction of the free flow of urine from the kidney. Untreated, it leads to progressive atrophy of the kidney as a result of back pressure.

Ileal conduit diversion

Surgical technique for the diversion of urine after a patient has had their bladder removed. Urine is transported from the ureters (the tubes draining urine from the kidneys) to a stoma on the abdominal wall using an isolated segment of small intestine.

Neurogenic

Originating in the nerves or nervous tissue.

Neuromuscular electrical stimulation

Procedure used to strengthen healthy muscles or to maintain muscle mass during or following periods of enforced inactivity. This helps to maintain or gain range of motion, to facilitate voluntary motor control, and temporarily reduces spasticity when the nerve supply to the muscle is intact. This procedure involves sending small electrical impulses through the skin to the underlying nerves and muscles to create an involuntary muscle contraction.

Overactive bladder

Produces symptoms of urinary urgency, with or without urge incontinence, usually with an increased frequency of micturition. The strong, sudden need to urinate is usually caused by involuntary contractions of the bladder or 'bladder spasms'.

Pelvic floor muscle training

Daily training programme to strengthen the muscles that support the uterus, bladder and other pelvic organs and help prevent accidental urine leakage. Also called Kegel exercises or pelvic muscle rehabilitation.

Pelvic floor prolapse

Loss of muscle tone and/or ligamentous elasticity resulting in the descent of the uterus or other pelvic organs into the vagina. If severe, the prolapse can protrude out of the vaginal orifice.

Pressure-flow studies

Simultaneous measurement of bladder pressure and flow rate during the voiding phase of the micturition cycle. The test is used to assess the process of bladder emptying. For example, bladder outflow obstruction can be diagnosed if there is a low urinary flow rate in conjunction with a raised bladder pressure during voiding.

Prompted voiding

A behavioural management programme that is used to encourage people to initiate their own toileting. It usually involves positive reinforcement and education of both the person with incontinence and their carer(s).

Renal scintigraphy

Photographic recording, using a gamma camera, of the distribution of a radioisotope (radioactive substance) given by injection. The radioisotope accumulates in the kidneys, allowing pictures to be produced showing details of both kidney structure and function.

Sacral agenesis

A condition that exists when either part or all of the sacrum is absent due to a failure of the sacral spine to develop normally. In many cases, some or all of the nerves that supply the pelvic organs will also have failed to develop normally.

Spina bifida

A condition in which the bones of the spine do not close due to a failure of normal development in the fetus. In cases of myelomeningocoele, the bony abnormality is accompanied by abnormal development of the spinal cord or nerves and their covering membranes, which leads to abnormalities in the nerve supply to the lower limbs and pelvic organs.

Spinal dysraphism

A general term that encompasses a number of different developmental abnormalities of the spine and spinal cord, of which spina bifida is an example.

Stress incontinence

Stress urinary incontinence describes a symptom, a sign and a diagnosis, although it is only following urodynamic investigation that a diagnosis of urodynamic stress incontinence can be made. This condition is defined as 'the involuntary leakage of urine during increased abdominal pressure in the absence of a detrusor contraction'.

Urethral tape and sling surgery

A procedure that restores bladder control for people who lose urine when they cough or exercise. The urethral tape procedure involves positioning an artificial tape under the urethra, which is the tube that runs from the bladder through which you urinate. The tape will then rest like a hammock under the urethra, giving support and maintaining continence. A urethral tape consists of a thin mesh ribbon that is placed in order to provide support to the urethra. Urethral sling surgery involves placing a sling around the urethra to lift it back into a normal position and to exert pressure on the urethra to aid urine retention. The sling is attached to the abdominal wall. Also see autologous fascial sling surgery.

Urodynamic investigations

Investigation of the function of the lower urinary tract (the bladder and urethra) using physical measurements such as urine pressure and flow rate, as well as clinical assessment. Video-urodynamic investigations involve using a dye to fill the bladder enabling X-rays of the lower urinary tract to be taken during filling and emptying of the bladder.

  • National Institute for Health and Care Excellence (NICE)