Dysfunctions of the Lower Urinary Tract and Affective Symptoms

191 Pages·2017·1.67 MB·English

by  Désirée Vrijens

Dysfunctions of the Lower Urinary Tract and Affective
Symptoms
Citation for published version (APA):
Vrijens, D. M. J. (2017). Dysfunctions of the Lower Urinary Tract and Affective Symptoms. [Doctoral
Thesis, Maastricht University]. Datawyse / Universitaire Pers Maastricht.
https://doi.org/10.26481/dis.20170706dv
Document status and date:
Published: 01/01/2017
DOI:
10.26481/dis.20170706dv
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UNIVERSITAIRE
PERSMAASTRICHT
ISBN 978 94 6159 707 6
Dysfunctions of the Lower Urinary Tract
and Affective Symptoms

Proefschrift

ter verkrijging van de graad van doctor aan de Universiteit Maastricht,
op gezag van de Rector Magnificus, Prof. dr. Rianne M. Letschert,
volgens het besluit van het College van Decanen,
in het openbaar te verdedigen
op donderdag 6 juli 2017 om 16.00 uur
door

Désirée Maria Josephina Vrijens
Promotores:
Prof.dr. Ph.E.V. Van Kerrebroeck (1e promotor)
Prof. dr. G. A. van Koeveringe (2e promotor)

Co-promotor:
Dr. C. Leue

Beoordelingscommissie:
Prof.dr. H.W.M. Steinbusch (voorzitter)
Prof. dr. A.A.B. Lycklama à Nijeholt (Universiteit Leiden)
Prof.dr. J.G. Nijhuis
Prof.dr. De Ridder (Universiteit Leuven)
dr. J.J.M.H. Strik
Contents
Chapter 1 General introduction 7
Chapter 2 Affective symptoms and the overactive bladder – 31
a systematic review
Journal of Psychosomatic Research 2015;78:95-108
Chapter 3 Prevalence of anxiety and depressive symptoms and their 65
association with pelvic floor dysfunctions - a cross sectional cohort
study at a Pelvic Care Centre
Neurourol and Urodyn. 2017 Febr 21, (Epub ahead of print)
Chapter 4 The relationship between self-consciousness/awareness and 79
bladder sensations – a comparative study of patients with
overactive bladder and healthy volunteers
Accepted Low Urin Tract Symptoms
Chapter 5 Associations of psychometric affective parameters with urodynamic 93
investigation for urinary frequency.
Low Urin Tract Symptoms 2016 Jun 12, (Epub ahead of print)
Chapter 6 Screening for depression and anxiety in patients with storage or 105
voiding dysfunction: A retrospective cohort study predicting
outcome of sacral neuromodulation
Neurourol Urodyn. 2016 Nov;35(8):1011-1016
Chapter 7 Patient reported outcome after treatment of urinary incontinence 119
in a multidisciplinary pelvic care clinic
Int J Urol 2015;22:1051-7
Chapter 8 General discussion 137
Summary 159
Nederlandse samenvatting 163
Valorisation 169
Dankwoord 177
Curriculum Vitae 183
Lijst van publicaties 185
List of abbreviations 187

5

1
Chapter
General introduction

7

General introduction
INTRODUCTION
A Chinese proverb of 2000 years ago says: “The bladder is the mirror of the soul!”. The
bladder reflects our feelings, and wellbeing and we can all recognize that increased
anxiety or stress can lead to subjective changes in voiding behaviour. Just before the
start of a running a race there is a large queue of athletes in the restrooms, who have to
void repeatedly. This suggests that psychological influences on voiding, which can lead
to increased frequency and urgency, are also present in healthy individuals. In our clini-
cal practice in the multi-disciplinary pelvic care clinic, we noticed a high rate of comor-
bidity between lower urinary tract dysfunction and affective symptoms. This intriguing
observation led to this thesis.
LOWER URINARY TRACT FUNCTION
Structure and function
The lower urinary tract consists of the urinary bladder, the lower part of both ureters
together with the ureterovesical junction, the urethra and external urethral sphincter,
also referred to as the rhabdosphincter. In men the prostate is considered part of the
urethra.
The bladder is a hollow organ that is situated within the pelvis. However the bladder
can ascend even up to the umbilicus during filling. The bladder wall consists of five lay-
ers from inside out: the urothelium, the lamina propria with fibro-elastic connective
tissue, the muscularis mucosa, the detrusor and the bladder serosa 1. The muscle of the
bladder, the detrusor, is composed of smooth muscle fibres, and consists of three lay-
ers. The fibres in the middle layer of the detrusor are arranged circular, and form an
internal sphincter at the level of the bladder neck. The outer layer is composed of longi-
tudinal fibres, that are thickest posteriorly at the bladder base 1.
Physiology and neuro-anatomy
The function of the bladder is to store and to expel urine at a convenient time and
place. In the adult, normal bladder capacity is approximately 400-500 ml, which results
in a voiding frequency of 5-7 times a day, mostly at lower volumes. The predominant
function of the bladder is that of a reservoir, to store urine at low pressures, even with
large filling volumes. As a result of the visco-elastic properties of the bladder wall and
the inhibition of filling phase detrusor contractions, the bladder is compliant, and the
pressure inside of the bladder can remain low 2.
9