Session 7 Flashcards
(13 cards)
Detrusor muscle is innervated by?
Sphincter of bladder?
Parasympathetically by pelvic nerves (S2,3,4)
Somatic innervationby pudenal nerves (S2,3,4)
What effect does a lower motor neurone lesion have on the bladder? And surrounding area?
It relaxes the destrusor muscle completely, so there is large residual urine which can lead to incontinence. S2,3,4 effected so reduced perinatal sensation and lax anal tone.
Describe storage phase neuronal activity of the bladder
Max capacity of bladder?
Stretch receptor in bladder send neurone to spinal chord. Synapse on sympathetic ganglion which inhibit destrusor (relax) and excite IUS. L centre in cerebral cortex exciting somatic motor fibres (pudendal nerve) to excite the EUS. So storage phase is sympathetic.
500ml
Describe voiding phase with neuronal activity
How does m centre open up EUS\IUS.
Stretch receptors synapse on parasympathetic ganglion which then excites detrusor (contraction). This isn’t regulated. So at high levels of pressure a branch of sensory neurone activates m centre in cerebral cortex. M centre is controlled by exciters/inhibitory neurones, if exciters the sensory is relayed down to excite the same parasympathetic ganglion which will go an excite detrusor.
It inhibits the L centre and it’s sympathetic.
Receptor on IUS? Relate to drugs?
Receptor in detrusor muscle supplied by parasympathetic ganglion? And drug relationship?
Same but sympathetic?
EUS receptor?
A1 receptor, antagonist can cause IUS relaxation
M3, agonist can excite detrusor
B3,agonist will relax the bladder
Nachr
Why does a higher spinal chord injury result in a mituration overdrive?
Parasympathetics in spinal chord have two excitory neurones but majority are inhibitory to dampen down mituration. If lesion the inhibitory willl be damaged leaving just the excitory from stretch receptor and m centre so into mituration overdrive. High pressure detrusor contractions and poor sphincter coordination (Dyssynergia)
What happens in a lower spinal lesion/cauda equina causes?
Other symptoms?
Parasympathetic ganglion damaged. So can’t feel fullness of bladder and can’t contract so perpetual storage reflex so volume will be very high and dribbling may occur. Due to low detrusor pressure and large residual urine so incontinence.
S2,3,4 damaged so reduced perinatal sensation and lax anal tone.
Why babies are incontinent?
Only have a simple voiding reflex arc due to lack of myelination so neurones exciting inhibiting m centre not developed so no control on parasympathetic ganglion.
Symptoms of storage issue?
Void issues?
Frequency,urgency,nocturia
Slow stream,spraying,intermittent
4 types of incontinence?
Stress urinary incontinence-involuntary leakage on exertion/sneezing.
Urgency urinary incontinence-involuntary leakage accompanied by urgency.
Mixed urinary incontinence- associated urgency and on exertion
Overflow incontinence
Risk factors of incontinence?
Measuring methods to investigate?
Preganancy,pelvic prolapse,UTI,Age,obesity, family predisposition
Frequency volume chart, bladder diary
Lifestyle changes if incontinent?
Contained incontinence?
Training if SUI? Drugs?
Surgery? For SUI
Lower fluid,stop smoking,weight loss, timed voiding
Indwelling catheter, pads
Pelvic floor training, Dulexitine give noradrenaline to EUS.
Retropubic suspension procedure-correct position of urethra
Fascial sling procedure-supports urethra and augments bladder
Male artificial sphincter
Intramural bulking agents(collagen) improves urethra resistance
Drug treatment of UUI’s?
Surgery of UUI’s?
Anticholinergics on M2
B3 adrenoreceptor agonist,mirabegron, increase bladder storage
Sacral nerve neuromodulation
Autoaugmentation
