Voiding

Question 1

smooth muscle sphincter contraction and relaxation is controlled by?

Answer 1

alpha-adrenergic fibers of the SNS

Question 2

detrusor muscle contraction and relaxation is controlled by?

Answer 2

cholinergic fibers of the PNS

Question 3

striated muscle sphincter contraction and relaxation is controlled by?

Answer 3

somatic nervous system

Question 4

what are the two main phases of voiding?

Answer 4

filling/storate and emptying

Question 5

beta adrenergic fibers of the SNS are (stimulated/inhibited) during the filling phase to (contract/relax) the bladder

Answer 5

stimulated; relax

Question 6

cholingeric fibers of the PNS (stimulate/inhibit) (contraction/relaxation) of the bladder during the filling phase

Answer 6

inhibit contraction

Question 7

the pudendal nerve is (stimulated/inhibited) during the filling phase to (contract/relax) the external sphincter

Answer 7

stimulated; contract

Question 8

during the emptying phase, the pudendal nerve is (stimulated/inhibited), leading to (contraction/relaxation) of the external sphincter

Answer 8

inhibited; relaxation

Question 9

during the emptying phase, the (SNS/PNS) is stimulated to (contract/relax) the detrusor muscle

Answer 9

PNS; contract

Question 10

what type of receptor is stimulated during detrusor contraction?

Answer 10

M3 muscarinic receptors

Question 11

stimulation of the PNS (what spinal cord level?) results in bladder _____ and (storage/emptying)

Answer 11

S2-S4; contraction; emptying

Question 12

stimulation of the SNS at spinal cord level ____ results in bladder _____ via __ fibers, and bladder outlet/urethral ____ via __ fibers

Answer 12

T11-L2; relaxation (beta); contraction (alpha)

Question 13

stimulation of the pudendal nerve at spinal cord level _____ results in urine (storage/emptying)

Answer 13

S2-S4; storage (keeps it in)

Question 14

the cerebral cortex is responsible for (stimulating/inhibiting) the sacral micturition center

Answer 14

inhibiting (tells you not to go)

Question 15

the pontine micturition center coordinates (contraction/relaxation) of the urinary sphincter

Answer 15

relaxation (when the bladder contracts)

Question 16

efferent arm of sacral micturition center (S2-S3) results in (parasympathetic/sympathetic) signals that cause bladder (contraction/relaxation)

Answer 16

parasympathetic; contraction

Question 17

three bladder causes of filling/storage problems

Answer 17

poor compliance (fibrosis, nerve injury); decreased capacity (small bladder); overactivity (aging, neurologic)

Question 18

outlet cause of filling/storage problems

Answer 18

weak or damaged sphincter muscle does not stay closed, leading to incontinence (pregnancy, prostatectomy)

Question 19

bladder cause of emptying problems

Answer 19

decreased or absent bladder contraction (neurogenic, decreased sm muscle activity - overdistension from diabetes)

Question 20

outlet causes of emptying problems

Answer 20

overactive outlet (pelvic floor dysfunction) or obstruction (prostatic, stricture, mass, sling, organ prolapse)

Question 21

signs of filling/storage problem

Answer 21

urinary urgency, frequency, or incontinence

Question 22

signs of emptying problem

Answer 22

hesitancy, straining, weak stream, intermittent stream, incomplete emptying, urinary retention, overflow incontinence

Question 23

two other symptoms that you should consider when evaluating the urinary system

Answer 23

GI, neuro

Question 24

common medication that can cause urinary retention

Answer 24

sudafed

Question 25

uroflow measures?

Answer 25

flow rate and volume (emptying phase)

Question 26

if a patient has decreased flow, think? (2 things)

Answer 26

outlet resistance/obstruction or poor detrusor function

Question 27

if post-void residual is elevated, think? (2 things)

Answer 27

poor detrusor function or increased outlet resistance/obstruction

Question 28

urodynamics measures ____ phase(s), is (cheap/expensive), and invasive

Answer 28

both phases (storage and emptying)

Question 29

which voiding problem cannot be treated?

Answer 29

poor detrusor contraction

Question 30

treatment of storage problems related to bladder compliance, capacity, or overactivity

Answer 30

anticholinergics to help relax bladder (side effects = dry)

Question 31

botox can be used to tx?

Answer 31

bladder overactivity

Question 32

when storage problems are related to outlet incompetence, tx includes?

Answer 32

physical therapy, weight loss, sling, collagen injection to manually obstruct urethra

Question 33

tx of bladder-related emptying problems

Answer 33

no meds to improve detrusor contraction; options include catheterization and urinary diversion

Question 34

tx of outlet-related emptying problems: external sphincter dysynergia

Answer 34

bypass it with intermittent cath; botox to deaden sphincter

Question 35

tx of outlet-related emptying problems: pelvic floor dysfunction

Answer 35

PT to learn to relax muscles; electrical stimulation; stress reduction

Question 36

tx of outlet-related emptying problems: prostatic obstruction

Answer 36

prostatectomy if cancer; alpha blockers to relax prostate (tamsulosin, alfuzosin); 5-alpha reductase inhibitors to shrink prostate (finasteride, dutasteride); surgery to trim prostate (TURP)