236 bladder dysfunction Flashcards
What is bladder compliance?
change in bladder volume divided by change in bladder pressure at bladder capacity
How does bladder compliance affect renal function?
long-term high bladder pressures can cause hydronephrosis and loss of renal function
What bladder controls are under parasympathetic innervation?
micturition
pontine micturition center (coordination of detrusor, sphincter)
pelvic splanchnics
What bladder controls are under sympathetic innervation?
suprapontine = inhibits PMC
pontine storage center = increased striated sphincter activity
hypogastric nerve = increases accommodation to filling; increased tone of IUS
Pudendal (somatic)= increased striated muscle activity, increases striated sphincter activity in EUS
Where is the origin of the pontine micturition center? What does it do?
rostral pons
central coordination of detrusor and sphincter (allowing micturition to occur)
parasympathetic
What pelvic splanchnics are associated with bladder control?
S2-S4
Where is the origin of the suprapontine control of micturition? What does it do?
cortex
inhibits PMC to block micturition
What is the origin of the hypogastric nerve to the bladder? What does it do?
T10-L2
increases accommodation to filling, increases tone of internal urethral sphincter
What is the origin of the pudendal nerve? What does it do for bladder control?
S2-S4
increases striated muscle activity, increases striated sphincter activity in external urethral sphincter (via ACh)
What role does the PMC play in voluntary control of the bladder?
it sends excitatory signals (makes the bladder want to pee)
inhibited by the suprapontine center, which is in the cortex and allows for conscious control of voiding
What is the impact of neurologic diseases above the PMC on bladder function?
detrusor overactivity in absence of coordination and pressure problems
aka “overactive bladder”
no source of inhibition from the cortex
What is the impact of neurologic diseases in the cervical spinal cord on bladder function?
detrusor sphincter dysnergia
loss of coordinating influence of PMC, leading to possible hydronephrosis due to sustained high bladder pressures
aka bladder and sphincter are squeezing at the same time, leading to high pressures
What is the impact of neurologic diseases in the thoracic spinal cord on bladder function?
detrusor sphincter dysnergia
high bladder pressures because bladder and sphincter are squeezing at the same time
can lead to hydronephrosis
What is the impact of neurologic diseases in the sacral spinal cord on bladder function?
detrusor sphincter dysnergia
variable loss of bladder compliance
What are the three “zones” of the lower urinary tract?
zone 1: smooth muscle detrusor (endoderm)
zone 2: trigone, bladder neck, and prostate –> internal urethral sphincter (mesoderm)
zone 3: external urethral sphincter (skeletal muscle)
