11.5 Neurogenic Urinary Tract Dysfunction

Question 1

Why are men less likely to present with urinary incontinence than women?

Answer 1

• Males have internal urethral sphincter, women have a weaker/not full one
• Males have a strong external sphincter, women’s can be damaged/denervated during childbirth
• Males also have a prostate, which helps to increase resistance
• Longer urethra also

Question 2

What is the role of the pelvic floor in preventing incontinence in women?

Answer 2

• Wraps around urethra, contracting during increased intrabdominal pressure

Question 3

The two types of LUTS are storage and voiding. Give some examples of storage LUTS

Answer 3

• Urgency
• Increased daytime frequency/nighttime (nocturia) frequency
• Incontinence

Question 4

The two types of LUTS are storage and voiding. Give some examples of voiding LUTS

Answer 4

• Hesitancy
• Slow stream
• Splitting or spraying
• Straining

Question 5

Which of urinary voiding/storage are under sympathetic/parasympathetic control?

Answer 5

Storage: Sympa
Voiding: Parasympa

Question 6

Which nerves are responsible during storage/voiding of urine? What are their spinal levels, and types of neuronal activity?

Answer 6

Voiding:
- Pudendal (S2-S4), somatic; contracts external sphincter, which we can then relax
- Pelvic (S2-S4), parasympathetic; contracts detrusor and relaxes IUS

Storage:
- Hypogastric (T10-L2) sympathetic; contracts sphincters, relaxes detrusor

Question 7

Describe the brain pathway of afferent to efferent micturition signal

Answer 7

PAG -> PMC -> PAG -> down to spinal cord

Question 8

What are the two main aims of neurogenic bladder control?

Answer 8

• Protect upper urinary tract
• Improve quality of life

Question 9

What are the four types of causative lesion in Neurogenic Lower Urinary Traction Dysfunction (NLUTD)?

Answer 9

1. Suprapontine
2. Pontine
3. Suprasacral
4. Sacral/subsacral

Question 10

What are some causes of suprapontine NLUTD? What is the pattern of dysfunction?

Answer 10

• Causes include CVA, head injury, dementia, cerebal palsy; (any cerebral damage)
• Pattern of dysfunction includes detrusor overactivity (loss of control), loss of voluntary voiding, loss of sensation (can’t reach somatosensory cortex)

Question 11

What are some causes of sacral/subsacral NLUTD? What is the pattern of dysfunction?

Answer 11

Causes: myelomeningocele, MS, diabetes, iatrogenic from surgery
Features: acontractile/overactive detrusor, incompetenturethra, loss of bladder sensation

Question 12

Causes of pontine vs suprasacral NLUTD?

Answer 12

Pontine: multiple systems atrophy, parkinson’s, MS
Suprasacral: spinal cord injury, MS

Question 13

Clinical manifestations of NLUTD

Answer 13

• Increased incontinence
• Recurrent UTI (stasis…)
• Hydronephrosis
• Oliguria (if underactivity)