8.6 Neuropathic Bladder Flashcards
Is your bladder under control of the brain under normal circumstances ?
Yes, from after baby learned to control bladder.
It is a learned reflex. Urination is influenced by opportunity and stress
What is the bladder sphincters made up of?
External - striated muscle
Internal - smooth muscle
How functional are the 2 sphincters in both genders?
Female - external mostly active
Male - both reactive
What happens when we void our bladder with the sphincter and muscles?
- sphincters relax
- urethral muscle relax
- detrusor muscle in bladder contracts
What is the guarding reflex of the bladder?
As a reflex the external and internal sphincters are always contracted and the bladder muscle always relaxed
Neurotransmitters
Central - in brain
Spinal cord
Neurotransmitters around the bladder and sphincters
- pelvic nerve:parasympathetic; ACH as a neurotransmitter, binds to receptor [bladder]
- hypogastric nerve: sympathetic; noradrenaline is neurotransmitter; if stim = bladder will contract; part of guarding mechanism [bladder + urethra]
- pudendal nerve: somatic nerve that acts on external urethral sphincter; ACH as neurotransmitter acts on nicotinic receptors; if stim = sphincter relax [external sphincter]
ACH - acetilecoline
What are the 2 types of classification of neuropathic bladders?
- Supraspinal - in brain
- Suprasacral - above outflow of scrum (above S2,3,4)
- Infrasacral - inguinal region
OR
- Upper motor neutron - all suprasacral + supraspinal
- Lower motor neutron - inguinal
Causes of each type of neuropathic bladder:
- Supraspinal
- Suprasacral
- Infrasacral
1. Supraspinal
- stroke
- traumatic brain injury
- blunt brain injury
- penetrating
- cancer / tumour spreading
2. Suprasacral
- car accidents (break neck)
- thoracic spine injury (thoracic and lumbar spine join)
-> DSD - uncoordinated contraction of bladder (detrusor sphincter dyssnergia)
3. Infrasacral
- injury to spinal colum (L1)
- stab, car accident, gun shot
- trauma
- tumours (prostate, kidney, breast , colon cancer)
-> big flasset bladder = no contraction takes place (sacral spinal cord not coordinated)
How can Diabetes Mellitus impact bladder function?
- sensory and motor dysfunction
- only after pt have had DM for very long time (only later in life)
Sensory
- regenerative nerve fibres at end of bladder is impaired
- cannot feel bladder is full; bladder over fills
- over streching of bladder
- bladder muscle become ischaemic; replaced by collagen and fibrosis tissue
- bladder cannot contract very well
- bladder overdestended
- infection
Motor
- peripheral neuropathy
- somatic and pelvice nerves are affected
- bladder doesn’t contract well
- worse bladder emptying = infections
Microvascular
- small blood vessels are obliterated in DM
-> ischaemia
How is the bladder affected by Parkinson’s disease?
- tardikineses - cannot relax external sphincter
- takes long time to initiate urination
- pt have bladder contraction against sphincter that doesn’t relax
-> dyssynergia
What impact does CVA have on bladder?
Cerebral accident
- return to reflexive bladder emptying
- doesn’t have full control over bladder emptying
What impact does pelvic surgery have on bladder?
- spinal nerves, hypogastric nerves and pelvic plexus damaged
- infrasacral injury
Define the non-neurogenic neurogenic bladder
Hinman Syndrome (HS)
- voiding dysfunction of bladder
- neuropsychological origin
- functional bladder outlet obstruction in absence of neurologic defects
- external sphincter very well developed and keeps contracting when bladder is contraction
- younger pt (mostly girls)
Define dysfunctional voiding
- dyssynergic striated sphincteric activity in absence of proven neurological aetiology
- present at any age with spectrum of storage and voiding symp that may resemble florid neurogenic bladder
- umbrella term
