Neurogenic Bladder Dysfunction Flashcards
What happens during the storage phase of urination? What controls it?
Urethra contracts, detrussor relaxes
Sympathetic innervation
What are the different muscles of the bladder and what innervates them?
Detrussor muscle = muscarinic cholinergic, beta adrenergic
Urethral muscle = alpha adrenergic
External sphincter muscle
What happens during the voiding phase of urination? What innervates it?
Urethra relaxes and the detrussor contracts
Parasympathetic innervation
What nerves are important for bladder function?
Pelvic nerve important for contraction of detrussor muscle
Pudendal nerve innervates the external sphincter muscle
Where are the alpha adrenergic receptors located in the bladder?
Bladder neck
What do the alpha adrenergic receptors do during storage and voiding?
Stimulated during storage
Blocked during voiding
Where are the beta adrenergic receptors located in the bladder? What are their status during voiding and storage phases?
Located in the bladder body
Stimulated in storage
Blocked in voiding
Where are the cholinergic receptors located? When are they stimulated and blocked?
Located all over the bladder
Stimulated during voiding
Blocked during storage
Which drugs facilitate emptying of the bladder?
Prazosin blocks sympathetic receptors (beware of vasodilation)
Diazepam blocks striated muscle
Bethanecol provides cholinergic stimulation but is no longer available because can have some very nasty side effects
Which drugs facilitate storage of urine in the bladder?
Phenylpropanolamine = alpha agonist
Propantheline = anticholinergic
Dithylstilbestrol = oestrogen only used in dogs
Tesosterone cypionate = testosterone but only used in dogs
Why should we maintain the bladder?
Welfare as it is very uncomfortable
Prevent urine scalding and cystitits
Prevent stretching of muscle tight junctions which can cause permanent damage
Aid voiding or manual expression
What is the UMN bladder?
Increased sphincter muscle tone so it is difficult to express the bladder
How do you treat the UMN bladder?
Diazepam +/- prazoin and then manually express or closed collection system
What procedure is contraindicated if the bladder is very full?
Cystocentesis
