Urinary and Sexual Dysfunction Flashcards Preview

Neurology > Urinary and Sexual Dysfunction > Flashcards

Flashcards in Urinary and Sexual Dysfunction Deck (16):
1

What brain regions are necessary for volitional control of micturition?

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

2

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

the lateral pontine micturition center

3

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

4

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

5

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

6

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

through the pudendal nerves to the striated sphincter muscles

7

What is a normal PVR?

less than 50 ml

8

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

capacity is decreased
compliance is reduced

9

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

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

10

What will cause a spastic bladder?

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

11

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

12

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

13

What will happen to urination in spinal cord injury?

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

14

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

diabetes is the big out
amyloidosis
gillaine-barre
injury to pelvic nerves with local radiation or surgery

15

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

Desmopressin

Intravesical capsaicin

botulinum toxin

16

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

duloxetine