Urodynamic studies and Neuropathic bladder

Question 1

A muscle that forms the layer of the urinary bladder

Answer 1

Detrusor

Question 2

The internal urethral sphincter is under involuntary control by

Answer 2

Sympathetic stimulation

Question 3

External urethral sphincter is striated under voluntary control by the

Answer 3

Pudendal nerve

Question 4

3 layers responsible for the contraction of the bladder wall

Answer 4

Outer longitudinal
Middle circular
Inner longitudinal

Question 5

In the inner longitudinal layer the convergence of the muscle fibers froms a thickened bladder neck which functions as

Answer 5

Internal smooth-muscle sphincter

Question 6

Main function of the bladder

Answer 6

Storage of urine

Question 7

Normal capacity of bladder averages

Answer 7

350mL

Question 8

Micturition reflex is located in

Answer 8

Sacral cord

Question 9

When the sensation of fullness is transmitted to the sacral cord, what happens on the motor arc of the reflex

Answer 9

It causes a powerful and sustained detrusor contraction and urination if voluntary control is lacking

Question 10

Normal residual urine volume in the bladder

Answer 10

0, but for clinical purposes <50 – normal

Question 11

Only organ that is voluntary and at the same time under CNS control

Answer 11

Bladder

Question 12

The door for the exit of the urine

Answer 12

Sphincteric unit

Question 13

These 2 have to coordinate to affect the normal voiding pattern

Answer 13

Sphincter unit and the ureterovesical junction

Question 14

2 sphincters involved in the sphincteric unit

Answer 14

Internal involuntary smooth muscle

External voluntary striated

Question 15

Location of the internal involuntary sphincter

Answer 15

Near the bladder outlet

Question 16

Location of the external sphincter

Answer 16

Proximal to the prostatic urethra

Question 17

This unit prevents backflow

Answer 17

Ureterovesical unit

Question 18

The ureterovesical unit is located at

Answer 18

Trigone

Question 19

The superficial trigone is above the

Answer 19

Waldeyer’s sheath

Question 20

This supplies the urinary bladder with autonomic nerves

Answer 20

Pelvic plexus

Question 21

Parasympathetic innervation is derived from

Answer 21

S2-s4

Question 22

Afferent innervation

Answer 22

Pudendal nerve

Hypogastric plexus

Question 23

Parasympathetic efferent innervation

Answer 23

Pelvic plexus

Question 24

You can control urination by trying to contract the

Answer 24

External sphincter

Question 25

What happens in the fight or flight mechanism why there’s inhibition of urination

Answer 25

Sympathetic stimulation increases contraction of the internal urethral resistance of the sphincter

Question 26

Micturition centers

Answer 26

Spinal cord (sacral) and Pons

Question 27

Disorders of the bladder secondary to neuromuscular disease

Answer 27

Neuropathic bladder disease

Question 28

This center elicits a direct reflex in infants

Answer 28

Sacral micturition center

Question 29

Integration center for signals from bladder, cerebral cortex and hypothatlamus

Answer 29

Periaqueductal gray

Question 30

How does the pontine micturition center initiate voiding

Answer 30

Distention stimulates the PMC then it will send signals for the detrusor to contract and the sphincter to relax thus voiding

Question 31

End result of detrusor contraction

Answer 31

Sphincter relaxation

Question 32

Although micturition and urine storage are primary functions of the autonomic nervous system, these are under voluntary control from

Answer 32

Suprapontine cerebral centers

Question 33

pertains to disorders of the nerve conduction to the bladder

Answer 33

Neuropathic neuromuscular

Question 34

Lesions above sacral micturition center

Answer 34

Bladder spasticity Dementia, CVA, MS, tumors Spinal cord injury

Question 35

Lesions below sacral micturition center

Answer 35

Flaccid | Injury at the center, s2-s4

Question 36

Involuntary contractions with coordinated sphincter function indicates a lesion where

Answer 36

Above the brainstem

Question 37

What will happen initially if there’s a lesion above the brainstem

Answer 37

Detrusor areflexia

Question 38

Ddx if lesion is above the brainstem

Answer 38

``` Cystitis Chronic urethritis Interstitial cystitis Cystocele Bladder outlet obstruction ```

Question 39

Sphincter is not coordinating with the bladder

Answer 39

Dyssynergia

Question 40

T or F: Normally if the bladder contracts the sphincter should also contract

Answer 40

False: if the bladder contracts the sphincter should relax

Question 41

If there’s involuntary bladder contractions without sensation the lesion is where

Answer 41

Complete spinal cord lesions from level T6-S2

Question 42

If there’s bladder spasticity/contracted bladder where’s the lesion

Answer 42

Above the sacral micturition center (S2-S4)

Question 43

Loss of inhibition from higher centers resuls in

Answer 43

Overactive bladder and sphincter bhvr on the segmental lvl

Question 44

Spastic neuropathic bladder is typified by

Answer 44

``` Reduced capacity Involuntary detrusor contractions High intravescial voiding pressures Marked hypertrophy of the bladder wall Spasticity of the pelvic striated muscle Autonomic dysreflexia in cervical cord lesions ```

Question 45

If there’s frequency in urination the lesions is located in

Answer 45

Spinal cord

Question 46

Manifestation if there’s complete spinal cord lesion

Answer 46

Sensation of bladder fullness becomes absent

Question 47

What happens initially if there’s spinal shock

Answer 47

Urinary retention

Question 48

One of the first indications of return of detrusor reflex activity

Answer 48

Strong detrusor contraction in response to filling with cold saline

Question 49

Test used to differentiate upper from lower motor neuron lesions early in the recovery phase

Answer 49

Ice water test

Question 50

If the injury is at the upper motor what would be the manifestations

Answer 50

Spastic – spontaneous spasms in the extremeties, leakage of urine or stool

Question 51

If the injury is at the lower motor what would be the manifestations

Answer 51

Flaccid

Question 52

Flaccid neuropathic bladder is aka

Answer 52

Neurogenic areflexic bladder

Question 53

Direct injury to the peripheral innervations of bladder or sacral segments S2–4 results in

Answer 53

Flaccid paralysis of the bladder

Question 54

Principal urinary symptom of flaccid neuropathic bladder

Answer 54

Retention with overflow incontinence

Question 55

s/sx of neurogenic overactive bladder

Answer 55

Lack of true sensation of fullness and involuntary urination

Question 56

Used to assess the integrity of the urethra and identify stricture sites

Answer 56

Cystourethroscopy, ureteroscopy

Question 57

Abnormal bladder capacity caused by flow into the blind sacs or diverticula

Answer 57

Cystocoele

Question 58

This is done if there’s urethral sphincter dyssynergia

Answer 58

Sphincterectomy

Question 59

Treatmen of spastic neuropathic bladder includes

Answer 59

``` Foley catheterization Sphincterectomy Sacral rhizotomy Neurostimulation Urinary diversion ```

Question 60

implanting a bladder pacemaker to stimulate sacral nerve roots and accomplish bladder evacuation

Answer 60

Neurostimulation

Question 61

Treatment for spinal shock

Answer 61

Foley catheterization Suprapubic cystostomy Control of infection and calcium stone prevention

Question 62

How is crede maneuver done

Answer 62

Manually pushing on the suprapubic area

Question 63

This is indicated for hypertrophy of the bladder neck or an enlarged prostate

Answer 63

Transurethral resection of the bladder neck

Question 64

Effect of parasympathomimetic drugs

Answer 64

They provide increased bladder tonus to help contract effectively

Question 65

Complications of neuropathic bladder

Answer 65

Recurrent UTI Hydronephrosis (d/t ureteral reflux or obstruction) Stone formation

Question 66

Techniques used to obtain graphic recording of activity in the urinary bladder, urethral sphincter and pelvic musculature

Answer 66

Urodynamic studies

Question 67

Urodynamic studies are used to evaluate

Answer 67

Bladder and sphincter function and act of voiding

Question 68

Study of flow of urine from urethra

Answer 68

Uroflowimetry

Question 69

Used to measure reservoir function of lower urinary tract

Answer 69

Cystometry

Question 70

Used to monitor urethral activity

Answer 70

EMG