Bladder & Micturition

Question 1

3 layers of bladder

Answer 1

1) outer peritoneum
2) detrusor muscle
3) inner mucosal layer

Question 2

male muscles responsible for continence

Answer 2

1) smooth muscle fibers of prostate

2) muscle bundles around bladder neck

Question 3

female muscle responsible for continence

Answer 3

1) bladder neck muscle fibers

2) mid-urethral complex

Question 4

parasympathetic innerv of lower Urinary tract

1) innerv…
2) activ …

Answer 4

1) innerv detrusor muscle
2) muscle contraction and micturition

S2-S4–> pelvic nerves –> parasympathetic innerv–> bladder contract

Question 5

sympathetic innerv of lower urinary tract

1) inhib…
2) incr tension in…

Answer 5

1) inhib detrusor contract
2) incr tension in smooth muscle of bladder and urethra preventing micturition

T10-L2 –> hypogastric nerve –> sympathetic innerv –> bladder –> inhib prevent micturition

Question 6

motor innerv of lower urinary tract

1) bladder, pelvic floor, urethral sphincter arise from..
2) sensation transmitted…

Answer 6

1) bladder, pelvic floor, urethral sphincter arise from segments S2-S4 of psinal cord
2) sensation of fullness stretch from long neurons from spinal cord to pons

S2-S4 —> pudental nerves –> external urethral sphincter —> muscles of pelvic floor –> bladder contract

Question 7

central nervous system input to lower urinary tract

Answer 7

choosing when to void

Question 8

loss of central cortical inhibiton over sacral areas in diseases like ___ lead to incontinence

Answer 8

dementia, stroke, parkinson’s

Question 9

dorsal root carries … signals to spinal cord

ventral root carries … signals from spinal cord

Answer 9

motor (bladder –> spinal cord –> DRG –> cerebral cortex

sensory

Question 10

Dysfunction of storage in bladder results in ___

Answer 10

1) freq (small bladder)
2) urgency (bladder can’t be filled)
3) urge incontinence (OAB)

Question 11

normal afferent storage reflex

1) generated by …
2) sensory fibers in pelvic nerve enter sacral cord via ___

Answer 11

1) generated by filling bladder

2) sensory fibers in pelvic nerve enter sacral cord via sacral DRG

Question 12

dysfunction of afferent storage reflex leads to

Answer 12

unmyelinated C fiber –> reflex reorganization in spinal cord injury and multiple sclerosis

Question 13

normal efferent storage reflex

1) efferent responses controlled at ____ by activating ___
2) inhib ___

Answer 13

1) controlled at supraspinal levels by activating somatic motor neurons
2) inhib detrusor motor neuron

Question 14

dysfunction of efferent storage response occurs when

Answer 14

stroke
frontal lobe lesion
MS
SCI

–> detrusor overactivity

Question 15

normal micturition reflex must ___

dysfunction of micturition reflex leads to

Answer 15

override storage activity

hesitancy, weak stream, incomplete bladder emptying

Question 16

What is micturition cycle

KNOW!!!

Answer 16

1) incr wall tension in bladder
2) afferent input overcomes pontine micturition threshold –> micturition begins
3) decr pudental nerve, reflax pelvic floor, detrusor neurons are freed and fire
4) proximal urethra opens
5) bladder contracts

Question 17

Dysfunction of micturtion cycle

Answer 17

disturbances or lack of coord from SCI or MS –> hesitancy, weak stream, incomplete emptying

Question 18

urination reflex cycle

DON’T NEED TO KNOW

Answer 18

1) bladder fills
2) sympathetic nerves
3) closes bladder neck, relax bladder dome
4) detrusor pressure > urethral resistance –> voiding
5) symp and somatic tone decr, parasympathetic impulse cause bladder to contract

Question 19

Voiding dysfunction

2 types of outflow dysfunction

Answer 19

1) overactive = overflow incontinence

2) underactive = stress incontinence

Question 20

Voiding dysfunction

2 types of bladder dysfunction

Answer 20

1) overactive = urge incontinence

2) underactive = overflow incontinence

Question 21

pmhx assoc with incontinence

Answer 21

1) diabetes
2) bowel problems/constipation
3) cva, MS, parkinson’s

Question 22

shx assoc with incontinence

Answer 22

1) bladder outlet
2) spinal surgery
3) radical pelvic surgery (prostatectomy, APR)

Question 23

Anal wink reflex

absence of anal wink suggests

Answer 23

touching mucocutaneous junction of perianal skin –> contraction of anal sphincter

sacral nerve disease

Question 24

voluntary sphincter contraction during DRE

absence indicates

Answer 24

1) intact pelvic floor

2) sacral or peripheral nerve injury

Question 25

bulbocavernosus reflex (S2-4)

absence indicates

Answer 25

squeezing glans penis –> contraction of external anal sphincter

sacral nerve damage

Question 26

lab evaluation

Answer 26

1) UA
2) BUN, Cr, PSA
3) hematuria = cytology, cystoscopy

Question 27

red flags for women

red flags for men

Answer 27

STRESS INCONTINENCE
1) hematuria, UTI, cancer, voding difficulty, urogenital fistula

OBSTRUCTION IF NOT NEURO OR RECENT PROSTATE SURGERY
2) hematuria without infection, urethral obstruction, prostate nodule

Question 28

3 major types of incontinence

Answer 28

1) stress urinary incontinence
2) urge incontinence
3) mixed

Question 29

approach to urge incontinence

Answer 29

1) rule out neuro
2) bladder outlet obstruction
3) risk factors for transitional cell carcinoma of bladder

Question 30

define OAB

Answer 30

urgency +/- incontinence usu with freq and nocturia

Question 31

most incontinent men fail to effectively contract

Answer 31

pelvic floor muscle

Question 32

pharm treatments for OAB

Answer 32

1) antimuscarinic agents

2) relieved by inhib involuntary bladder contract and incr bladder capacity

Question 33

afferent signals vs. efferent

Answer 33

afferent from bladder to spinal cord

efferents from spinal cord to bladder affected by atropine, oxybynin, tolterodine

Question 34

effect of oxybutynin

Answer 34

smooth muscle relaxant to incr bladder storage

Question 35

management of refractory OAB with intravesical botox

Answer 35

inhib vesicular neuronal blockade

Question 36

define stress urinary incontinence

Answer 36

involuntary sudden loss of urine during incr intra-abd pressure

ex: laughing, sneezing, cough, exercising

Question 37

Separate btwn overactive bladder and stress incontinence

Answer 37

overactive bladder
+ urgency + freq + large leakage with incontinence

no leaking during phys activity

Question 38

causes of stress urinary incontinence

Answer 38

1) pelvic muscle strain and loss
2) childbirth
3) menopause

Question 39

a

Answer 39

a

Question 40

drugs to treat SUI

Answer 40

1) alpha agonists = possibly interact with estrogen = pseudoephedrine, ephedrine
2) estrogen

Question 41

management of ISD in men

Answer 41

1) radical, simple prostatectomy
2) radiation
3) neurogenic = spina bifida, pelvic fracture, surgery

Question 42

behavioral and phys therapy effective in ___to improve continence

Answer 42

early post-op phase

Question 43

etiology of male lower urinary tract obstruction

Answer 43

bladder neck/prostate

1) BPH
2) prostate/bladder cancer
3) stricture after surgery, trauma

urethra

1) stricture
2) urethral cancer

Question 44

symptoms of male lower urinary tract obstruction

Answer 44

storage symptoms = freq, urgency, urge incontinence and nocturia

emptying symptoms = hesitance, dribbling, dysuria

Question 45

management to relieve male lower urinary tract obstruction

Answer 45

1) 5a-reductase inhib
2) a1-adrenergic blocker
3) surgical therapy

Question 46

urethral stricture usu occurs in ___ and often due to ___

Answer 46

younger men due to trauma to bulbar urethra