8- Neuro control of micturition and incontinence

Question 1

What centre helps support contience

Answer 1

Lateral centre

Question 2

Where do the sympathetic neurons go to

Answer 2

Detrusor muscles and internal urinary sphincter

Question 3

What effect do sympathetic branches have on bladder msucle

Answer 3

Inhibitory

Question 4

What receptor does the sympathetics work on at the detrusor muscle

Answer 4

B3

Question 5

What receptor does the parasmpathetic branch work on at the bladder muscle and what is the effect

Answer 5

M3 and excitatory

Question 6

What receptors and neurotransmitter does the sympathetics use

Answer 6

Adrenoceptors - noradrenaline

Question 7

What leads to the M centre stimulation

Answer 7

High stretch

Question 8

What is the effect of M centre stimulation

Answer 8

Stimulates parasympathetics= detrusor excited

Inhibits M centre= inhibition of excitation of EUS by pudendal nerve

Question 9

What nerve works on the external urinary sphincter

Answer 9

Pudendal nerve.

Question 10

Where does the sensory neurons synapse with para

Answer 10

S2-S4

Question 11

Where does the sensory neurons synapse with symp

Answer 11

Enter at sacral region but synapse in lower thoracic region T10-L2

Question 12

What is the conscious control of the M centre

Answer 12

Paracentral lobules send excitatory and inhibitory influences to M centre.

Question 13

Two effects of sympathetics

Answer 13

Inhibit detrusor

Excite IUS

Question 14

What receptor at IUS

Answer 14

A1

Question 15

What happens to the pressure in bladder and urine fills

Answer 15

Bladder stretches so very little increase in pressure until over 500.

Question 16

What level is pudendal nerves

Answer 16

S2,3,4

Question 17

What level are pelvic (parasymp) nerves

Answer 17

S2,3,4

Question 18

What examination findings would a lower motor neuron lesion cause (i.e. cauda equina)

Answer 18

Low detrusor pressure, large residual volume, overflow incontinence.
Reduced perianal sensation
Relaxed PR exam.

Question 19

What would a upper motor neuron lesion cause (i.e. transection)

Answer 19

High pressure detrusor contractions not coordinated with sphincters.
Back pressure to kidneys- dilated ureters

Question 20

Lower urinary tract symptoms

Answer 20

Storage: frequency, nocturia, urgency
Voiding: splitting, hesitancy, straining
Post: dribble, incomplete emptying

Question 21

4 types of incontinence

Answer 21

Stress, urgency, mixed, overflow

Question 22

Overflow

Answer 22

When high residual
Chronic retention
Chronic obstruction
Lower motor neuron lesion

Question 23

Stress

Answer 23

Involuntary leakage on effort or exertion

Sneezing or coughing

Question 24

Urgency

Answer 24

Involuntary leakage accompanied by or immediately preceded by urgency

Question 25

Mixed

Answer 25

Involuntary leakage associated with urgency and also exertion, effort, sneezing, coughing

Question 26

What is more common Overactive bladder or Stress UI

Answer 26

OAB- urgency, nocturia, increased frequency

Question 27

Risk factors for UI

Answer 27

``` Pregnancy, childbirth (less compliant) Age Obesity Drugs UTI Race Family predisposition Anatomical abnormalities ```

Question 28

What examination should be performed

Answer 28

BMI, abdo (exclude palpable bladder) Rectal exam- bladder and anal tone Females- stress test, vaginal exam

Question 29

Investigations- mandatory

Answer 29

Dipstick UTI, haematuria, protein, glucose Tumour, infection, diabetic

Question 30

Non invasive investigation

Answer 30

Frequency volume chart Bladder diary Residual volumes

Question 31

Optional investigations

Answer 31

Pad test Invasive urodynamics- pressure flow studies +/- videos Cystoscopy

Question 32

Mangagement

Answer 32

``` Fluid intake modify Weight loss Stop smoking Decrease caffeine Timed voiding Avoid constipation ```

Question 33

Contained incontinence

Answer 33

Indwelling catheter Sheath Pads

Question 34

Managing SUI | Exercise + drug

Answer 34

Pelvic floor training 8 contractions x 3 day for 3 months Duloxetine: norad and serotonin uptake inhibitor to increase activity in striated (EUS) sphincter during filling phase

Question 35

Surgery for SUI Female Male

Answer 35

Sling procedures Low tension vaginal tapes- supports mid urethra Intramural bulking- botox - 6 months Retropubic suspension- increase support by tightening pelvic floor Artificial sphincters Male sling

Question 36

Management UUI

Answer 36

Bladder training schedule - 6 weeks

Question 37

Pharmacological UUI

Answer 37

Anticholinergics- act on M3/M2 to block also work on other areas of body ie heart, smooth muscle, eye, salivary glands (Oxybutynin) B3 adrenoceptor agonist- increases bladder capacity to store urine Botox- inhibits Ach release causing targeted flaccid paralysis- 6 months

Question 38

Surgery UUI

Answer 38

Sacral nerve neuromodulation Autoaugmentation Urinary diversion

Question 39

Bedwetting

Answer 39

Enuresis- involuntary 2xweek over age of 5 with no CNS defects

Question 40

Secondary enuresis

Answer 40

Restarted after dry for 6 months

Question 41

Causes of primary enuresis

Answer 41

Lower urinary tract disorders

Question 42

Causes of secondary enuresis

Answer 42

UTI, constipation, diabetes, family problems, psychological problems, physical, neurological problems