Bladder and sexual Dysfunction Flashcards
What are complications that may occur if bladder volume is not kept under 500mL?
- Vesicoureteral reflux
- Overflow incontinence
- Hydroureter
In SCI patients, what may be the only clinical sign of pregnant lady going into labor?
Autonomic dysreflexia
What is the accepted normal bladder capacity
300-600 mL
Acute vs subacute CVA: what kind of neurogenic bladder does each get?
Acute CVA = flaccid areflexic bladder
Subacute CVA = spastic hyperreflexic bladder
Are people with SCI more likely to have reflexogenic or psychogenic erections?
Reflexogenic
What is the crede maneuver?
Applying Suprapubic pressure to help with voiding in an areflexic bladder
When patients do intermittent catheterization, what is the bladder volume goal?
Keep bladder volume <500mL
When do most women have return of menstruation after SCI
6-12 months after injury
What type of injury results in detrusor sphincter dyssynergia
Between the sacral (S2-4) and pontine micturition centers
What type of neurogenic bladder do SCI experience during spinal shock?
Areflexic bladder
What innervates the internal urethral sphincter
T11-L2 hypogastric nerve (sympathetic)
How many mL can bladder hold before first sensation of bladder filling occurs?
100mL
What is the main characteristic that differentiates umn vs lmn neurogenic bladder?
Umn bladder = spastic bladder
Lmn bladder = flaccid bladder
What level of SCI differentiates umn vs lmn bladder dysfunction
Above S2 = umn
Below S2 =lmn
Single worse predictive factor for inability of sperm to penetrate ovum
Leukocyte concentration in the semen
Which pathway mediates parasympathetic sacral micturition reflex
Pelvic and pudendal nuclei
How many mL can bladder hold before a patient experiences bladder fullness and a sense of urgency?
Fullness = 300-400 mL Urgency = 400-500 mL
What is the functional bladder capacity
Voided volume + residual volume
Loss of control from which central pathway results in detrusor sphincter dyssynergia?
Pontine mesencephalic nuclei
When can a patient with an indwelling catheter be switched to intermittent catheterization?
When patients can tolerate fluid restriction of 2L/day. About 7-15 days after injury.
What is detrusor sphincter dyssynergia
Detrusor hyperreflexia and sphincter hyperactivity
What SCI patient population are unable to get psychogenic erections
Patients with Complete UMN lesions
What pathway inhibits parasympathetic sacral micturition center
Corticopontine mesencephalic nuclei
When do you treat asymptomatic bacteriuria in SCI patients?
If they are undergoing an invasive procedure, or if culture is positive for urease producing organism
Which nerve carries sympathetic innervation to detrusor muscle?
Hypogastric nerve
Action of alpha-1 and Beta-2 receptors to bladder and urethra
Alpha-1 = contraction of internal sphincter at base of bladder Beta-2 = detrusor relaxation
How do you treat detrusor sphincter dyssynergia
Anticholinergics (such as oxybutyinin) Alpha blockers (-zosins)
What sexual dysfunctions do women have after SCI
Decreased libido
Amenorrhea
Multiple sclerosis: what type of neurogenic do patients get?
Spastic - detrusor hyperreflexia
What fibers sense bladder distention?
Myelinated A-delta fibers, which stimulates the parasympathetics
What %age of patients with complete UMN and complete LMN lesions are able to ejaculate?
Complete UMN = 5%
complete LMN = 18%
Which pathway coordinates bladder contraction and sphincter relaxation to allow peeing
Pontine mesencephalic nuclei
What somatic nerve allows voluntary control of external urethral sphincter
Pudendal nerve
What nerve has parasympathetic innervation to detrusor muscle
Pelvic nerve
If SCI occurs during pregnancy, how long should she get thromboprophylaxis for?
8 weeks
Most common upper urinary tract complication in SCI
Renal calculi
