17 control of bladder emptying

Question 1

What pushes urine down the ureter?

Answer 1

peristaltic waves from atypical smooth muscle cells

Question 2

What are the 2 types of kidney stones?

Answer 2

nephrolithiasis

ureterolithiasis

Question 3

name 2 treatments for kidney stones

Answer 3

percutaneous nephrostomy

extracorporeal shock wave lithotripsy

Question 4

What would a bladder empty state of over 100ml suggest?

Answer 4

significant urinary retention

Question 5

What alterations might be made to urine in the lower urinary tract?

Answer 5

singalling molecules

cells…

Question 6

What are the layers to the bladder wall?

Answer 6

urothelium
lamina propria
detrusor smooth muscle
serosa

Question 7

What are the adaptations of the urethlium surface?

Answer 7

tight junctions

umbrella cells

Question 8

What are the contents of the lamina propria?

Answer 8

blood vessels
lymphatics
nerves
interstitial cells of Cajal
connective tissue

Question 9

What is the role of the interstitial cells of Cajal?

Answer 9

mediate communication between urothelium and detrusor

Question 10

What is the arrangement of detrusor muscle?

Answer 10

smooth muscle bundles
basket weave

continuous with urethra

Question 11

What does ParaSNS stimulate in the detrusor?

Answer 11

ACh : M3 -> contraction

Question 12

What does SNS sitmulate in the detrusor?

Answer 12

NAd : B3 -> relaxation

Question 13

What receptor in detrusor is often targeted pharmacologically, and why?

Answer 13

Beta-3 adrenoreceptor

it is specific to the bladder

Question 14

How is signalling coordinated to the detrusor muscle fibres?

Answer 14

synchronous activity of ParaNS neurones

gap junctions

Question 15

What about detrusor changes down to the urethra?

Answer 15

its’ behaviour

Question 16

What are the layers of muscle in the bladder + urethra?

Answer 16

inner layer SM

outer layer somatic - skeletal

Question 17

What is the role of the somatic system in urinary continence?

Answer 17

active

keeps striated sphincter contracted

Question 18

What is the role of the sympathetic system in urinary continence?

Answer 18

active
constricts SM sphincters
keeps storage element relaxed

Question 19

What is the role of the parasympathetic system in urinary continence?

Answer 19

inactive

Question 20

What is the role of the somatic system in urinary voiding?

Answer 20

inactive

Question 21

What is the role of the sympathetic system in urinary voiding?

Answer 21

inactive

Question 22

What is the role of the parasympathetic system in urinary voiding?

Answer 22

active

storage element walls contract

Question 23

What higher centres are involved in the voiding reflex?

Answer 23

peri-aqueductal grey matter

pontine micturition centre

Question 24

What does stimulation of the voiding reflex do?

Answer 24

inhibits somatic outflow
relaxes EUS

switches off symp relexation
switches on para, bladder contraction

Question 25

How can you measure urethral and intravesical pressure?

Answer 25

catheter

Question 26

How can you measure urethral EMG?

Answer 26

stick an electrode through the anterior wall of the anus for men yeah, i know

Question 27

What needs to occur before the bladder wall contracts?

Answer 27

EUS relaxes | urethral pressure falls

Question 28

What 6 problems might cause urinary incontinence?

Answer 28

``` UTI spinal cord disorder stroke pelvic floor injury atonic bladder ```

Question 29

How does a UTI cause urinary incontinence?

Answer 29

chemical stimuli increase bladder activity and hence urge to void

Question 30

What spinal cord disorders may cause urinary incontinence?

Answer 30

injury | MS

Question 31

Why might you get detrusor overactivity?

Answer 31

with age, as a response to prostate enlargement prostate enlargement increases resistance to flow

Question 32

What is atonic bladder secondary to?

Answer 32

autonomic neuropathy

Question 33

What happens in atonic bladder?

Answer 33

bladder fills, pressure rises sufficiently to leak incontinence - small volume, high frequency urination

Question 34

How might women get stress incontinence?

Answer 34

increase in pressure forces back the posterior wall of the urethra normally this would be prevented by the anterior wall of the vagina, although this can be weakened

Question 35

What 3 surgical techniques may be used to treat stress incontinence?

Answer 35

synthetic mid-urethral tape open colposuppression autologous rectus fascial sling

Question 36

What group of drugs might you use to treat stress incontinence?

Answer 36

over-active bladder drugs | OAB drugs

Question 37

What are the 3 main types of OAB drugs?

Answer 37

anti-muscarinic drugs botulinum toxin beta-3 adrenoreceptor agonists

Question 38

Name an antimuscarinic drug

Answer 38

oxybutynin

Question 39

Name a beat-3 adrenoreceptor agonist

Answer 39

mirabegron

Question 40

Whta OAB drugs might target sensory neurones?

Answer 40

resiniferatoxin | capsaicin

Question 41

What OAB experimental drugs are there?

Answer 41

PDE-5 inhibitors | K+ channel activators

Question 42

What 3 drugs are first-line treatment to women with OAB or UTI?

Answer 42

Oxybutynin Tolterodine Darifenacin

Question 43

What might cause urinary outflow obstruction?

Answer 43

prostomegaly (BPH) | urethral sphincter

Question 44

What surgical technique might you use to treat urinary outflow obstruction?

Answer 44

transurethral resection of the prostate | TURP

Question 45

What medical techniques might you use to treat urinary outflow obstruction

Answer 45

alpha-adrenoreceptor antagonists | 5-alpha-reductase inhibitors

Question 46

How might alpha-adrenoreceptor antagonists treat urinary outflow obstruction? name 2 examples

Answer 46

relax prostate SM terazosin tamsulosin

Question 47

How might 5-alpha-reductase inhibitors treat urinary outflow obstruction? name 1 example

Answer 47

reduce hypertrophy finasteride