Structure and Function of Lower Urinary Tract

Question 1

layers of bladder wall

Answer 1

transitional epithelium (aka urothelium)
lamina propria
submucosa
detrusor muscle
adventitia/serosa

Question 2

do males or females have thicker detrusor muscles

Answer 2

males

Question 3

how does the brain know the bladder is getting full

Answer 3

as the tight junctions between cells stretch signals are sent to the brain of the bladder filling
afferent neurons carry the signal to the dorsal horn of the sacral spinal cord

Question 4

what system innervates the detrusor muscle

Answer 4

postganglionic parasympathetic system

Question 5

what cells make up the urothelium

Answer 5

multilayered epithelium
apical/umbrella cells

Question 6

what are the functions of the urothelium

Answer 6

forms a barrier
does afferent signalling - sends messages to CNS

Question 7

which layer of the bladder are the blood vessels and nerves found

Answer 7

lamina propria

Question 8

what is the function of the lamina propria

Answer 8

it coordinates the urothelium and the detrusor muscle

Question 9

what type of cells are found in the lamina propria of the bladder

Answer 9

myofibroblasts

Question 10

what is the detrusor muscle made from

Answer 10

smooth muscle arranged in bundles
it is a functional syncytium (fused cells with multiple nuclei)

Question 11

what makes up the stroma of the bladder

Answer 11

collagen and elastin

Question 12

what is the outer layer of the bladder

Answer 12

adventitia/serosa

Question 13

what two things form the barrier function of the bladder

Answer 13

glycosamino glycans layer
tight junctions

Question 14

what is and isn’t allowed to pass through the barrier layer of the bladder

Answer 14

urea, Na+ and K+ can pass passively
water passage is resisted but it is not completely waterproof

Question 15

does bladder pressure increase when the urine increases in volume

Answer 15

no as the bladder is high compliant

Question 16

what term describes the bladders ability to expand in response to urine without losing its tension

Answer 16

it is highly compliant

Question 17

coordination of what two movements are required for volitional voiding

Answer 17

detrusor contraction
urethral relaxtion

Question 18

what type of reflex comes under higher centre control in potty training

Answer 18

spino-bulbar reflex

Question 19

at what volume of urine does the bladder begin to feel full

Answer 19

250ml

Question 20

at what volume of urine does the bladder begin to feel uncomfortabel

Answer 20

500ml

Question 21

which nerves control volitional voiding

Answer 21

S2, 3 and 4 (Onuf’s nucleus)

Question 22

where is volitional voiding modulated

Answer 22

pontine micturition centre

Question 23

what is facilitation

Answer 23

contraction of the detrusor and relaxation of sphincter when bladder less than full (e.g. in anxiety states)

Question 24

what is the likely result on voiding in a spinal cord injury

Answer 24

the CNS can no longer inhibit the reflex arc
so the bladder is left to empty under its reflex arc

Question 25

how much urine is normal to pass at one time and how many times a day

Answer 25

300-400ml 4-5 times per day

Question 26

what does a bladder diary measure

Answer 26

input and output over three consequetive days frequency nocturia hyperhydration effects of caffiene alcohol binge drinking

Question 27

what are the storage lower urinary tract symptoms

Answer 27

urgency frequency nocturia urinary incontinence

Question 28

what are the voiding lower urinary tract symptoms

Answer 28

hesitancy poor flow intermittency terminal dribbling

Question 29

causes of decreased bladder capacity

Answer 29

reduced compliance reduced functional capacity neurogenic bladder (e.g. MS) irritation (due to bladder stones or tumour)

Question 30

if someone wakes up to pee once every night do they have nocturia

Answer 30

no needs to be more than once

Question 31

why do those with peripheral oedema often have nocturia and what is the treatment

Answer 31

blood fluid can get to kidneys when lying down given diuretic in afternoon to get rid of excess fluid before sleeping

Question 32

definition of nocturnal polyuria

Answer 32

production of more than one third of 24 hour urine output between midnight and 8am

Question 33

causes of poor flow, hesitancy, dribble

Answer 33

usually due to bladder outlet obstruction or underactive or hypocontractile bladder (e.g. due to spinal cord injury)

Question 34

cause of intermittency

Answer 34

prostatic enlargement

Question 35

cause of post-void dribble

Answer 35

release of urine retained in bulbar/prostatic urethra

Question 36

what is straining

Answer 36

the use of abdominal muscles to void

Question 37

types of incontinence

Answer 37

urge - involuntary loss of urine associated with strong desire to void, involves detrusor contraction stress - involuntary loss of urine when intra-abdominal pressure rises without detrusor contraction (e.g. coughing, sneezing, laughing, exerting)

Question 38

which type of incontinence involves detrusor muscle contraction

Answer 38

urge incontinence

Question 39

what is IPSS

Answer 39

internal prostate symptom score

Question 40

what 8 questions are included in the IPSS

Answer 40

frequency nocturia weak urinary stream hesitancy intermittency incomplete bladder emptying urgency quality of life

Question 41

what is involved in the urodynamic assessment

Answer 41

pressure transducers are placed on the bladder and rectum which measures the pressure here in filling and voiding patient is asked to cough periodically

Question 42

how is detrusor activity calculated in a urodynamic assessment

Answer 42

pressure from bladder - pressure from rectum rectum pressure = abdominal pressure

Question 43

results of a urodynamic assessment for someone with bladder outlet obstruction

Answer 43

no unstable contractions during filling no leak whilst coughing during filling very high pressure and low flow during voiding

Question 44

what order are symptoms of outflow obstruction likely to arise in

Answer 44

1. storage symptoms 2. voiding symptoms 3. decompensation of detrusor (chronic retention, bladder failure and renal failure)

Question 45

management of over active bladdr

Answer 45

lifestyle (e.g. cutting back on caffeine) medication (e.g. anti-muscarinics, selective B3 adrenoreceptor agonist, intradetrusor botox)

Question 46

management of stress incontinence

Answer 46

pelvic floor exercises weight loss surgery

Question 47

management of bladder outlet obstruction

Answer 47

alpha blockers 5ARI surgery