The Lower Urinary Tract

Question 1

Female Pelvis

Answer 1

insert diagram

Question 2

Where does the ureter enter the bladder?

Answer 2

posterolaterally

Question 3

Male Pelvis

Answer 3

insert diagram

Question 4

mALE pELVIS

Answer 4

insert diagram

Question 5

Posterior Relations of the bladder in males:

Answer 5

• ductus deferens (runs through the
  inguinal canal, below bladder and
  attaches to seminal vesicles)
• seminal vesicles (either side)
  (connects to the prostate via)
• ejaculatory ducts

Question 6

Vesicouterine pouch is a

Answer 6

reflection of peritoneum

Question 7

The uterus lies in an —— position

Answer 7

anteverted
(tips forward at the cervix)

Question 8

How full does the bladder have to be to palpable and where does it protrude?

Answer 8

• 300ml
• anterior to the pubic symphysis
• strips the peritoneum of the
  anterior bladder wall

Question 9

What lies inferior to the bladder?

Answer 9

Levator ani (pelvic floor muscles)

Question 10

Internal Bladder Anatomy

Answer 10

insert slide

Question 11

Why does urine generally not reflux up the ureter?

Answer 11

• no valve
• inserts diagonally through detrusor
  muscle wall
• as bladder fills, pressure rises,
  muscle will close the ureter opening
  hence urine in distal ureter can not
  reflux up

Question 12

Trigone of bladder embryological origin:

Answer 12

mesoderm

Question 13

What is the trigone?

Answer 13

• smooth triagnular region of bladder
• formed by two ureteric orifices and internal urethral orifice
• very sensitive to expansion, once
  stretch signal to brain to need to
  empty
• signals become stronger as bladder
  continues to fill

Question 14

Bladder embryological origin:

Answer 14

endoderm (apart from trigone)

Question 15

Where is the ureter in relation to uterine arteries?

Answer 15

• inferior
• bridge over water

Question 16

Where is a potential site of ureteric injury in a hysterctomy?

Answer 16

Where the ureter runs under the uterine artery and vein

Question 17

Female Pelvis

Answer 17

insert diagrams

Question 18

Bladder mucosa is called

Answer 18

urithelium

Question 19

bladder wall and epithelium

Answer 19

insert

Question 20

Transitional cell epithelium is impermeable to

Answer 20

water and electrolytes due to a highly keratinised cellular membrane synthesised in the Golgi

Question 21

Why is transitional cell epithelium impermeable?

Answer 21

importance in acting as an osmotic barrier between the contents of the urinary tract and surrounding organs/tissues

Question 22

What is the most impermeable membrane in the mammalian body?

Answer 22

Transitional cell membrane (bladder)

Question 23

Detrusor Muscle:

Answer 23

• longitudinal and circular smooth
  muscle bundles
• actin and myosin filaments aligned
  loosely and anchored to dense
  bodies
• contraction shortens and thins the
  whole cell
• muscarinic M2&3 cholinergic
  receptors
• muscle cells connected by gap
  junctions

Question 24

Bladder Innervation: Sympathetic:

Answer 24

• L2 nerve root
• sympathetic ganglia
• hypogastric plexus
• Splanchnics: Lesser, Least, Lumbar
• relaxation of bladder (not empty)

Question 25

Bladder Innervation: Parasympathetic:

Answer 25

- S2-4 nerve roots - Pelvic Splanchnic nerves - bladder contraction: emptying

Question 26

Bladder Innervation: Somatic Supply:

Answer 26

- S2-4 - Pudendal Nerve: urethral sphincter

Question 27

Bladder Innervation:

Answer 27

insert diagram

Question 28

Detrusor muscle cell alignment vs skeletal muscle

Answer 28

not sheets muscle bundles

Question 29

Bladder Receptors:

Answer 29

insert diagram ***

Question 30

Tablets use to inhibit bladder contraction act on M3 receptors so common side affect is

Answer 30

DRY MOUTH inhibition of salivary glands also have M3 receptors

Question 31

Bladder Complaince:

Answer 31

bladder relaxes as it fills to allow storage overdistension leads to renal retention insert

Question 32

Adaptations of Bladder Summary

Answer 32

insert slide

Question 33

Guarding Reflex:

Answer 33

- neck of bladder - bladder should empty to 0 - resting tone in external sphincter - as the bladder fills, reflex increases tone in external sphincter and bladder muscle relaxes (no emptying)

Question 34

What does the micturition reflex allow?

Answer 34

Bladder emptying

Question 35

Micturition Reflex:

Answer 35

- once bladder reaches certain volume and there is no cerebral control of the bladder - the body of the bladder will contract - neck of bladder, urethra and sphincters will relax - bladder will empty

Question 36

Where is the micturition reflex mediated?

Answer 36

Spinal cord

Question 37

Micturition reflex only triggered in unconscious patients. True or False?

Answer 37

True

Question 38

Bladder Filling Phase

Answer 38

- guarding reflex: mediated by symp and parasymp: PONTINE CENTER - orange = symp - blue = para insert diagram

Question 39

Voiding Phase:

Answer 39

insert (box 2 not needed)

Question 40

Types of Incontinence:

Answer 40

insert

Question 41

Incontinence:

Answer 41

insert

Question 42

Mechanisms of Drugs on the Bladder:

Answer 42

insert diagram

Question 43

Urge Incontinence Treatments: Diagram:

Answer 43

Insert - block M3 receptor: anticholinergics: dry mouth, not storing urine better because drinking more - B3 agonist: reduce contraction - botox detrusor muscle: reduce contraction: overdose may need catheterise

Question 44

Stress Incontinence: Treatment:

Answer 44

Insert - mostly non-drug treatment - surgery: more support to urethra - nicotine agonist: fluoxetine: external urethral sphincter: increase tone

Question 45

Urinary Retention:

Answer 45

- BPH: Benign Prostatic hyperplasia, enlarges, often bladder can overcome - can lead to urine retention - measured using a flow test - most empty in 30secs - can result in thickening of the bladder wall - can result in diverticula (outpouches) risk factor for stones - can transmit to high pressures in ureter and kidney (hydronephrosis)

Question 46

Urinary Retention:

Answer 46

insert slide

Question 47

Urinary Retention: Treatment:

Answer 47

insert slide - alpha blocker: relaxation of neck - S alpha reductase inhibitor: works on BPH, convert to testesterone to dihydrotestosterone blocked so reduce growth factors