Overactive Bladder

Question 1

A 68 year old male presents to your GP with his wife. He has shuffling gait, he moves very slowly and he has a resting tremor. He has had increased frequency and urgency of urination for the past few months. He reports sudden urges to urinate and occasional episodes of incontinence. He denies dysuria or hematuria.

Please state the most likely cause of his urinary symptoms

Answer 1

Overactive bladder
Thought to be related to the dysfunction of the basal ganglia which regulate the autonomic nervous system, which controls involuntary bodily functions such as bladder function.

Question 2

The GP suspects that the patient has an overactive bladder. What is an overactive bladder?

Answer 2

A condition characterized by a frequent and urgent need to urinate, often accompanied by urinary incontinence.

Question 3

Boutulinim toxin can be used to treat overactive bladder in patients who do not respond to other treatments. Please explain how this drug works?

Answer 3

Essentially it paralyzes the muscles that cause bladder contractions, thereby reducing the frequency and urgency of urination.
Boutulinum toxin works by blocking the release of a neurotransmitter called acetylcholine which prevents muscle contraction.

Question 4

Using this diagram, please explain the storage reflex of micturition

Answer 4

• Starts off with the sensory neurone that enter the spinal cord at S2-S4 detect stretch
• They synapse onto sympathetic neurones
• Inhibits the detrusor muscle and excite the IUS
• The pudendal nerve (somatic) arises from S2-S4 controls the EUS

Question 5

Using this diagram, explain the path urine takes from it’s production to where it is expelled.

Answer 5

Kidneys- ureter- bladder- urethra

Question 6

State the layers of this histology section of a ureter

Answer 6