Bladder Disorder, Urinary Incontinence, and Penile/Urethral Disorders Flashcards
(20 cards)
Efferent Pelvic Nerve
Acetylcholine to M3 receptor on bladder
PNS stimulation
Causes contraction of the detrusor muscle
Pudendal Nerve
Acetylcholine to nicotinic receptor or external sphincter
SNS
Causes sphincter contraction
Under conscious control
Hypogastric nerve
SNS
Releases NE to B3 receptor on bladder
-Causes relaxation of the detrusor muscle
Releases NE to alpha-1 receptor on internal sphincter
-causes contraction of internal sphincter
Afferent pelvic nerve
Stimulated by bladder stretch
Empty Bladder Physiology
Slow sensory impulse to sacral -> hypogastric nerve activated (B3 and alpha1)
Pons stimulates hypogastric nerve and inhibits pelvic (M3) nerve while stimulating pudendal nerve - nicotinic for contraction
SNS stimulated, PNS inhibited
Full Bladder Physiology
Urine stretches detrusor muscle - signaling the pelvic afferent nerve to increase firing
-bypasses thoracic and goes straight to pons
Pons inhibits hypogastric nerve (SNS) - no detrusor relaxation, internal sphincter relaxes, pelvic efferent stimulated causing detrusor contraction
Voiding Reflux
Initiation of voiding causes pelvic afferent nerve to continue signaling sacral->interneuron->PNS efferent stimulation
-This triggers detrusor contraction
Glomerular Bleeding
Red cell casts
Dysmorphic rbcs
Proteinuria with large % albumin
Interstitial Cystitis
Bladder Pain Syndrome (BPS)
Usually in 4th decade
Pain w/ filling that is relieved by emptying
UA to r/o cancer or infection
Tx: education, support
-Amitriptyline, Hydroxyzine, Pentosan polysulfate sodium (PPS)
Transient Incontinence Causes
DIAPPERS
Delirium
Infection
Atrophic vaginitis
Pharmacology
Psychological
Excessive urine production
Restricted mobility
Stool impaction
Causes of excessive urine production
Excessive urine production - diuretics
Increased ADH
Polydipsia
Hyperglysuria
Hypercalcemia
Urge Incontinence
Uninhibited contractions, detrusor overactivity, idiopathic, bladder abnormalities
Sudden urge with or after leakage
More common in men and older women
Tx: anticholinergics - increase capacity; oxybutynin for detrusor antispasmodic; miragebron for bladder relaxation
Stress Incontinence
Leakage with increased intraabdominal pressure w/o bladder contractions
Seconds after cough - urethral hypermobility or intrinsic sphincter deficiency
Prostate surgery most common cause
Tx: Surgical repair
Overflow Incontinence
Incomplete bladder emptying - continuous leakage
Detrusor underactivity or bladder outlet obstruction (BPH)
Tx: self-catheterizing
Immediate referral for Bladder Disorders
Incontinence w/ pain
UTI-free hematuria
Fistula
Complex neurological
Abnormal findings
Anterior and Posterior Urethral Stricture
Anterior: begins @ bulbar urethra, ends @ meatus
-commonly caused by straddling or penetrating injuries
Posterior: involved membranous and prostatic urethra
-commonly caused by urethral disruption via pelvic fracture
Balanitis
Inflammation of glans - most common in poor hygiene or uncircumcised
Pain, irritation, itching/burning, erythema, discharge, ulceration on PE
Tx: Clean, consider circumcision; bacitracin if bacterial infection; clotrimazole if fungal infection
Phimosis
Inability to retract foreskin from narrowing constriction, adhesions
Caused by balanitis, poor hygiene
erythema, itching, discharge with painful excretion/intercourse
Tx: Betamethasone cream is 1st line, circumcision 2nd
Paraphimosis
retracted foreskin becomes trapped proximal to glans
Emergency - leads to ischemia of glans & gangrene
Most common in elderly
Tx: Firm compression and manual reduction, circumcision
Peyronie’s Disease
Curvature of penis with erection due to plaque formation in tunica albuginea
Active phase: 1st 18-24 hours; penile pain, nodule, inflammation with some curvature
Chronic phase: stable plaque, penile angulation, loss of erectile activity
Tx: 1st 6 months - Vitamin E, ibuprofen, Colchicine
-after - Collagenase clostridium histolyticum - to break up the plaque, weekly Verapamil or surgery
