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Flashcards in Bladder Deck (55)
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What are the 4 surfaces of the bladder?

Inferolateral x2


What is the trigone?

Smooth triangular region formed by ureteral orifices and urethral orifice. Stretch sensors here


What cell types are found in the bladder lining?

Transitional epithelium lining (urothelium), also found in ureters
Detrusor muscle in wall


What prevents urine reflux during micturition?

Vesico ureteric valve, thickening of detrusor muscle


What is reflux nephropathy?

Incompetent vesico ureteric valve allows reflux of urine
Dilated ureter
Irregular renal outline, clubbed calyces, cortical scars


What is bladder support derived from?

Pelvic floor, perineal membrane & ligaments
Pubo-vesical ligament (female) - attach to pubic bone
Levator ani in both sexes - moves up when contracted
Pubo-prostatic ligament (male)


Where does blood supply to the pelvic viscera originate from?

Internal iliac artery
Bladder - vesical arteries


Describe venous drainage from pelvic viscera

Vesical & prostatic plexus to internal iliac vein


Describe lymph drainage from the pelvic viscera

External & internal iliac nodes
Sacral nodes
Umbilical region - follow urachus


What is an alternative to catheterisation if it is not possible?

Supra pubic catheterisation
Doesn't enter peritoneal cavity


Where is the reflex micturition centre?

Sacral spinal cord


How do autonomic nerves travel to pelvic organs?

Nerve plexus on posterolateral wall of pelvic cavity (inferior hypogastric)


What reinforces micturition?

Abdo wall muscles and valsava manoeuvre


What effect does parasympathetic activity have on the bladder?

Detrusor muscle contraction
Internal urethral sphincter relaxation


What voluntary control do we have over micturition?

Pudendal nerve contracts external urethral sphincter
Need to relax to urinate


What control does sympathetic activity have on the bladder?

Contract internal urethral sphincter (ejaculation and stage fright)
Detrusor muscle relaxation


Why are females more prone to incontinence?

Shorter urethra
No protection from prostate
Sphincters can be damaged from childbirth


What sphincters do females have?

Internal urethral sphincter
External urethral sphincter
Compressor urethrae
Sphincter urethrovaginalis


What sphincters do males have?

Internal urethral sphincter
External urethral sphincter
Compressor urethrae


What is micturition?

Conversion of the continuous involuntary production of urine into the intermittent, consciously controlled voiding of urine
Autonomic reflex under voluntary control
Bladder expands with little change in pressure (filling time), but after certain volume get increase in intravesical pressure
Urge to micturate (micturition reflex)


What is the function of the bladder?

Collection and low pressure storage of urine
Expansion without leaks or reflux to kidneys
No significant increase in pressure until full
Appropriate expulsion of urine


Describe bladder structure

Hollow, muscular organ
Outer connective tissue layer (Adventitia)
Lining is transitional cell epithelium (urothelium)
Specialised, multi-layered, remains intact as bladder expands
Inside appears yellow with rugae (folds), except trigone region


Describe the layers of the bladder wall

Inside: transitional cell epithelium
Lamina propria
Detrusor muscle (smooth muscle) (muscularis propria)
Outside: Adventia (connective tissue)


What is detrusor muscle?

Bands of interlaced smooth muscle with gap junctions – acts as one


Describe the structure of the Bladder neck/ posterior urethra

2-3 cm long detrusor muscle +elastic tissue


How do we prevent leakage and reflux to the kidney?

Vesicourethral angle: urethra passes through pelvic floor muscle at an angle from the bladder. Well toned floor maintains the angle
Sphincters: internal sphincter-detrusor muscle and elastic fibres, involuntary control (bladder neck); external sphincter, skeletal muscle, voluntary control
Angle ureters enter the bladder: Ureters enter at uppermost angles of
trigone, Enter obliquely through the detrusor and pass 1-2 cm beneath the bladder mucosa before emptying into the bladder


What is the capacity of the bladder? And when is the 1st urge to micturate noticed?

Bladder capacity 300-500ml
1st urge 150-300ml
Every 3-4 hours


Why do females have a faster urine flow rate?

Female: Max flow 40-50ml/s, weaker bladder neck/ sphincter
Male: Max flow 30-40ml/s, require more pressure as urethra is longer


What happens during voiding of urine from the bladder?

Co-ordinated relaxation of internal sphincter & contraction of detrusor
Relaxation of external sphincter
Urethral relaxation, detrusor contraction, relaxation of sphincters, relaxation of pelvic floor muscles, funnelling of the bladder neck


What Sacral response and conscious control is there to voiding in adults and children?

Children – spinal reflex, no control – nappies
Adults – learn to control external sphincter until want to urinate, higher centre stimulation of pudendal nerve, keeps external sphincter shut