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Flashcards in Urinary and Sexual Dysfunction Deck (16):

What brain regions are necessary for volitional control of micturition?

the dorsomedial frontal lobe connected to the medial region of the pontine micturition center


What brain regions are necessary for volitional urine storage by producing a powerful contraction of the urethral sphincter?

the lateral pontine micturition center


What happens, then, with damage to the pontine micturition center?

you lose inhibitory control over the spinal reflexes, so when the bladder becomes distended, the micturition reflex is automatically triggered at the level of the spinal cord without the patient's awareness or control and you get detrusor hyperreflexia and incontinence


What is the name of the circuit that controls a reflex arc starting in the bladder and projecting to the pontine micturition center with outflow connections to the parasympathetic sacral spinal motor nuclei?

spinobulbospinal circuit


The micturition reflex is a spinal segmental reflex arc with afferent fibers from the detrusor muscle to what nucleus?

Onuf's nucleus in the sacral spinal cord at S2-S4


Where do the efferent fibers form Onuf's nucleus go?

through the pudendal nerves to the striated sphincter muscles


What is a normal PVR?

less than 50 ml


In a spastic bladder, what happens to capacity? Compliance?

capacity is decreased
compliance is reduced


In an atonic bladder, what happens to capacity? compliance?

increased capacity and increased compliance, so you get low voiding pressure and flow rate


What will cause a spastic bladder?

it's an UMN problem due to lesions involving the frontal lobes, pons or suprasacral spinal cord


What will cause an atonic bladder?

It's a LMN problem due to lesions at the level of the conus medullaris, cauda equine or sacral plexus

or it may reflect peripheral nerve dysfunction


Voiding dysfunction occurs in 40-70% of patients with Parkinson disease. What is the most common finding on urodynamics?

detrusor hyperreflexia, but also pseudodyssynergia as a consequence of sphincter bradykinesia


What will happen to urination in spinal cord injury?

you get detrusor hyperreflexia with loss of compliance and detrusor-sphincter dyssynergia


What are some examples of diseases that can damage the peripheral nerves causing bladder dysfunction?

diabetes is the big out
injury to pelvic nerves with local radiation or surgery


What are some medications that can be used for hypersensitive bladder with urge incontinence?

the anticholinergic agents like tolterodine, oxybutynin, trospium and solifenacin

TCAs liks imipramine and amitriptyline


Intravesical capsaicin

botulinum toxin


What are some medications that can be used for stress incontinence/

slpha agrenergic agonist drugs like pseudoephedrine and midodrine to increase intrinsic urethral tone

also estrogen therapy either oral or vaginal