Bladder

Question 1

Define neuropathic

Answer 1

Disorder of function due to nervous system dysfunction

Question 2

Define neurourology

Answer 2

Management if neuropathic bladder, bowel and sexual function

Question 3

Define voiding

Answer 3

Voluntary initiation
Complete emptying

Question 4

What are the urethral sphincters

Answer 4

Bladder neck
- active during ejaculation only

Distal urethral sphincter
- smooth muscle compartment
- intrinsic striated sphincter (rhabdosphincter)
- Extrinsic striated sphincter (pelvic floor)

Question 5

Describe the bladder

Answer 5

Composed of multiple segments of smooth muscle with their associated ganglia

Each segment exhibits spontaneous activity ‘micromotions’

Cannot be denervated

Tone and characteristics as intrinsic characteristics

Question 6

What is innervation of micturition

Answer 6

Parasympathetics S234

C fibre local afferents

Sympathetic

Question 7

What is the function of the parasympathetic innervation of the bladder

Answer 7

Intermediolateral grey

Motor to bladder

Coordination of micromotions

Question 8

What is the function of C fibre local afferents

Answer 8

Reflex bladder contractions

Question 9

What is the function of sympathetic innervation of the bladder

Answer 9

Bladder
- receptive relaxation

Bladder neck - ejaculation

Sphincter
- smooth muscle
- non relaxing sphincter obstruction

Question 10

Describe the pontine micturition centre

Answer 10

Motor centre for autonomic control of the lower urinary tract

Descending fibres presumed to be in the antero-lateral funiculus

Question 11

What does storage of the bladder require

Answer 11

Relaxation of the detrusor muscle of the bladder

Simultaneous contraction of both internal urethral sphincter and external urethral sphincters

Question 12

Describe the stimulation of storage

Answer 12

Sympathetic innervation

Pons - responsible for co-ordination

Area involved in storage phase is pontine continence centre

Sympathetic nuclei T10-L2 and then to detrusor muscle and internal urethral sphincter

Question 13

Describe receptive relaxation

Answer 13

Co-ordinated relaxation of the detrusor muscle and contraction of the urethral sphincters. The rugae flattens (walls of bladder) allows bladder to keep a lower pressure than the urethral pressure

Question 14

Describe the voiding phase

Answer 14

Parasympathetic control

Pelvic nerve (S2-4) release Ach

Causes detrusor muscle to contract and increase intravascular pressure

Sympathetic stimulation to internal urethral sphincter causing relaxation

Conscious reduction in voluntary contraction of the external urethral sphincter from cerebral cortex allows passing of urine