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Urinary > 8- Neuro control of micturition and incontinence > Flashcards

8- Neuro control of micturition and incontinence Flashcards

1
Q

What centre helps support contience

A

Lateral centre

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2
Q

Where do the sympathetic neurons go to

A

Detrusor muscles and internal urinary sphincter

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3
Q

What effect do sympathetic branches have on bladder msucle

A

Inhibitory

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4
Q

What receptor does the sympathetics work on at the detrusor muscle

A

B3

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5
Q

What receptor does the parasmpathetic branch work on at the bladder muscle and what is the effect

A

M3 and excitatory

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6
Q

What receptors and neurotransmitter does the sympathetics use

A

Adrenoceptors - noradrenaline

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7
Q

What leads to the M centre stimulation

A

High stretch

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8
Q

What is the effect of M centre stimulation

A

Stimulates parasympathetics= detrusor excited

Inhibits M centre= inhibition of excitation of EUS by pudendal nerve

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9
Q

What nerve works on the external urinary sphincter

A

Pudendal nerve.

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10
Q

Where does the sensory neurons synapse with para

A

S2-S4

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11
Q

Where does the sensory neurons synapse with symp

A

Enter at sacral region but synapse in lower thoracic region T10-L2

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12
Q

What is the conscious control of the M centre

A

Paracentral lobules send excitatory and inhibitory influences to M centre.

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13
Q

Two effects of sympathetics

A

Inhibit detrusor

Excite IUS

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14
Q

What receptor at IUS

A

A1

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15
Q

What happens to the pressure in bladder and urine fills

A

Bladder stretches so very little increase in pressure until over 500.

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16
Q

What level is pudendal nerves

A

S2,3,4

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17
Q

What level are pelvic (parasymp) nerves

A

S2,3,4

18
Q

What examination findings would a lower motor neuron lesion cause (i.e. cauda equina)

A

Low detrusor pressure, large residual volume, overflow incontinence.
Reduced perianal sensation
Relaxed PR exam.

19
Q

What would a upper motor neuron lesion cause (i.e. transection)

A

High pressure detrusor contractions not coordinated with sphincters.
Back pressure to kidneys- dilated ureters

20
Q

Lower urinary tract symptoms

A

Storage: frequency, nocturia, urgency
Voiding: splitting, hesitancy, straining
Post: dribble, incomplete emptying

21
Q

4 types of incontinence

A

Stress, urgency, mixed, overflow

22
Q

Overflow

A

When high residual
Chronic retention
Chronic obstruction
Lower motor neuron lesion

23
Q

Stress

A

Involuntary leakage on effort or exertion

Sneezing or coughing

24
Q

Urgency

A

Involuntary leakage accompanied by or immediately preceded by urgency

25
Q

Mixed

A

Involuntary leakage associated with urgency and also exertion, effort, sneezing, coughing

26
Q

What is more common Overactive bladder or Stress UI

A

OAB- urgency, nocturia, increased frequency

27
Q

Risk factors for UI

A 
Pregnancy, childbirth (less compliant)
Age
Obesity
Drugs
UTI
Race
Family predisposition
Anatomical abnormalities
28
Q

What examination should be performed

A

BMI, abdo (exclude palpable bladder)
Rectal exam- bladder and anal tone
Females- stress test, vaginal exam

29
Q

Investigations- mandatory

A

Dipstick
UTI, haematuria, protein, glucose
Tumour, infection, diabetic

30
Q

Non invasive investigation

A

Frequency volume chart
Bladder diary
Residual volumes

31
Q

Optional investigations

A

Pad test
Invasive urodynamics- pressure flow studies +/- videos
Cystoscopy

32
Q

Mangagement

A 
Fluid intake modify
Weight loss
Stop smoking
Decrease caffeine
Timed voiding
Avoid constipation
33
Q

Contained incontinence

A

Indwelling catheter
Sheath
Pads

34
Q

Managing SUI

Exercise + drug

A

Pelvic floor training
8 contractions x 3 day
for 3 months

Duloxetine: norad and serotonin uptake inhibitor to increase activity in striated (EUS) sphincter during filling phase

35
Q

Surgery for SUI

Female

Male

A

Sling procedures
Low tension vaginal tapes- supports mid urethra
Intramural bulking- botox - 6 months
Retropubic suspension- increase support by tightening pelvic floor

Artificial sphincters
Male sling

36
Q

Management UUI

A

Bladder training schedule - 6 weeks

37
Q

Pharmacological UUI

A

Anticholinergics- act on M3/M2 to block
also work on other areas of body ie heart, smooth muscle, eye, salivary glands (Oxybutynin)
B3 adrenoceptor agonist- increases bladder capacity to store urine
Botox- inhibits Ach release causing targeted flaccid paralysis- 6 months

38
Q

Surgery UUI

A

Sacral nerve neuromodulation
Autoaugmentation
Urinary diversion

39
Q

Bedwetting

A

Enuresis- involuntary 2xweek over age of 5 with no CNS defects

40
Q

Secondary enuresis

A

Restarted after dry for 6 months

41
Q

Causes of primary enuresis

A

Lower urinary tract disorders

42
Q

Causes of secondary enuresis

A

UTI, constipation, diabetes, family problems, psychological problems, physical, neurological problems

Urinary (11 decks)

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