[10] Micturition

Question 1

Components: Bladder

Answer 1

Detrusor
Trigone
Ureterovesical Junction

Question 2

Urethra

Answer 2

Bladder Neck
External Sphincter
Prostate

Question 3

Nervous System Peripheral Nerves

Answer 3

Pudendal
Hypogastric
Pelvic

Question 4

Phases of Micturition

Answer 4

Filling/Storage

Voiding

Question 5

Define: Urodynamics

Answer 5

Study of hydrodynamics of urine storage and voiding

Question 6

Urodynamic Measurement Recordings

Answer 6

Intravesical Pressure
Abdominal Pressure
Sphincter Activity
Urine Flow Rate

Question 7

Normal Filling/Storage

Answer 7

No pressure
No leakage
No discomfort

Question 8

Tracing of Bladder Pressure Is?

Answer 8

Flat (? Not too sure)

Question 9

[Physiology of Normal Filling/Storage]
Detrusor

Compliant:
Control:

Answer 9

Compliant: Relaxes, accommodates
Control: No abnormal uncontrolled contractions

Question 10

[Physiology of Normal Filling/Storage]
Urethra and Sphincter

Competent:
Control:

Answer 10

Competent: Closed, contracts
Control: Contracts as needed

Question 11

[Physiology of Normal Filling/Storage]
Pelvic Floor

Contract:
Control:

Answer 11

Contract: To close
Control: Contracts more as needed

Question 12

Define: Detrusor Compliance

Answer 12

Ability to maintain low pressure despite increase of volume during filling

Question 13

[Anatomic Properties of Detrusor for Compliance]

Smooth Muscles

Answer 13

Viscoelastic property

Question 14

[Anatomic Properties of Detrusor for Compliance]

Submucosa

Answer 14

Collagen and Elastin

Question 15

[Anatomic Properties of Detrusor for Compliance]

Gap Junction Between Muscle Fibers

Answer 15

Slow Conduction

Question 16

[Anatomic Properties of the Outlet for Closure: Competence]
Bladder Neck Factors

Intrinsic Factors

Answer 16

Abundant smooth muscle and elastic connective tissue to the passive closure of bladder neck during filling

Question 17

[Anatomic Properties of the Outlet for Closure: Competence]
Bladder Neck Factors

Extrinsic Factors

Answer 17

Ligaments keep the neck of the bladder at an angle to the detrusor and provides support to the urethra

Question 18

Urethral Smooth Muscle Layers and Roles

Answer 18

Inner Longitudinal Layer: Uncertain Role

Outer Circular Layer: Closure at rest, Urethral Resting Pressure

Question 19

External Urethral Sphincter (Alternate Name)

Type of Fibers
Effect of Stress

Answer 19

Rhabdosphincter

Striated Slow Twitch Fibers exert a resting pressure during filling

During stress, cough valsalva, contraction causes rise in urethral pressure

Question 20

Inner Urethral Factor (Alternate Name)

Spongy Tissue Within the Submucosa

Answer 20

Collagen and Elastic Fibers

Venous Plexus

Question 21

What is a possible complication in women with regard to the Urethral Seal Effect?

Answer 21

It is hormonally regulated and postmenopausal women have thinner seals resulting in urinary leakage

Question 22

What do you call the Pelvic Floor Muscle Group

Answer 22

Pubovisceralls

Question 23

Muscles of the Pelvic Floor Muscle Group

Answer 23

Puborectalis
Pubovaginalis
Pubococcygeus
Pubourethralis

Question 24

Pelvic Floor Connective Tissue

Answer 24

Endopelvic Fascia

Question 25

Normal Voiding Characteristics

Answer 25

Adequate Pressure Good Flow/Stream No Discomfort

Question 26

[Anatomy and Physiology of Normal Voiding] Detrusor

Answer 26

Contractile | Control: Sustained stimulation to contract until empty

Question 27

[Anatomy and Physiology of Normal Voiding] Urethra and Sphincter

Answer 27

Calms Down: Relaxes and opens | Control: Inherent Contraction Inhibited

Question 28

[Anatomy and Physiology of Normal Voiding] Pelvic Floor

Answer 28

Calms Down: Relaxes and Opens | Control: Inherent Contraction Inhibited

Question 29

[Detrusor Contraction] Arrangement of smooth muscle fibers allowing sustained and complete emptying

Answer 29

Syncitium

Question 30

[Detrusor Contraction] Contraction of these muscles will close the distal ureter to prevent reflux of urine to the kidney

Answer 30

Trigonal Muscles

Question 31

[Coordination of the LUT] Filling and Voiding: Detrusor/Bladder Sphincter/Urethra Pelvic Floor

Answer 31

Detrusor/Bladder -> F: Relax V: Contract Sphincter/Urethra -> F: Contract V: Relax Pelvic Floor -> F: Contract V: Relax

Question 32

Micturition Switches

Answer 32

Cortical Center Rostral Pons Suprasacral Cord Sacral Cord Peripheral Nerves a. Hypogastric b. Pudendal c. Pubic

Question 33

[Inherent Actions] Cortical Center

Answer 33

Inhibitory to Pons

Question 34

[Inherent Actions] Pontine Center

Answer 34

Stimulatory to sacral cord | Inhibitory to suprasacral cord

Question 35

[Inherent Actions] Suprasacral (T10-12) Hypogastric Nerve

Answer 35

Stimulates internal urethral sphincter Inhibits detrusor Inhibits trigonal muscles