Bladder disorders

Question 1

synergistic effect

Answer 1

a situation where the combined effect of two or more elements (such as substances, factors, or actions) is greater than the sum of their individual effects

Question 2

where are niconitic receptors located

Answer 2

in the neuromuscular junction and the autonomic ganglia

Question 3

what is NANC (non adrenergic non cholinergic) transmission

Answer 3

type of neurotransmissions that do not involve noradrenaline, adrenaline, or acetylcholine, but use other neurotransmitters instead

examples of some neurotransmitters used are nitric oxide, ATP, neuropeptide …etc

Question 4

some inhibitory NANC neurotransmitters and their functions

Answer 4

Nitric Oxide: Causes smooth muscle relaxation, which is essential for blood vessel dilation, bronchodilation (in the airways), and relaxing muscles in the gastrointestinal tract.

Vasoactive intestinal peptide: Leads to smooth muscle relaxation, vasodilation, and increased glandular secretion.

Question 5

examples of excitatory neutrotransmitters of NANC transmission and their functions

Answer 5

ATP: In the autonomic nervous system, ATP may cause smooth muscle contraction by binding to purinergic receptors

** neuropeptide Y**: It helps modulate the effects of stress hormones and can reduce anxiety under certain conditions.

note that neuropeptide Y is one of the most potent apetite stimulating neutranmitters in the body.

Question 6

the prostate is located above the bladder, true or false

Answer 6

false, the bladder is above the prostate

note that the prostate is smaller as well

Question 7

bladder function

Answer 7

** to store urine produced by the kidneys and then release it from the body during urination**

note the bladder can store between 400ml-600ml of urine

Question 8

urine is 95% water, true or false

Answer 8

true

other components are urea, ammonia, dead body cells, hormones…etc.

Question 9

urinating 6-8 time daily is not normal, true or false

Answer 9

false because normally thats how many times people urinate

does not imply that urinating once or twice daily is abnormal

Question 10

the main features of the bladder

Answer 10

ureter
detrusor muscle
urethra
urethral sphincters

ureter transports urine from the kidneys into the bladder

Question 11

detrusor muscle function

Answer 11

contracts to push urine out of the bladder and relaxes ton store urine in the bladder

these muscles are spindle shaped, and non striated

Question 12

urethra function

Answer 12

The tube that carries urine from the bladder to the outside of the body for excretion

Question 13

internal urethral sphincter function

external urethral sphincter function

Answer 13

An involuntary muscle that helps keep urine in the bladder until it’s time to urinate.

A voluntary muscle that allows conscious control over the release of urine from the bladder

Question 14

micturition

Answer 14

the process of expelling urine from the bladder to remove toxic waste and metabolic products from the body

medical name for urination

Question 15

describe the filling stage of micturition

note there are two main stages of micturition

Answer 15

urine sent to the bladder from the kidneys

as the bladder fills its walls stretch, activating stretch receptors

detrusor muscle relaxes

internal urethral sphincter contracts, preventing urine from moving into the urethra

external urethral sphincter remains contracted

Question 16

the part of the brainstem that controls micturition is called

Answer 16

the pontine micturition center

aka Barrington’s nucleus

Question 17

describe the emptying(voiding) stage of micturition

Answer 17

as bladder volume reaches fullness, stretch receptors are activated

they send strong signals to the brain, increasing the urge to urinate

pontine micturition centre activates a reflex that causes the detrusor muscle to contract

internal urethral sphincter relaxes to allow urine flow into the bladder

external urethral sphincter relaxes for urination to occur

after urination has occured, detrusor muscle relaxes, internal urethral sphicter contracts, and external contracts to prevent further urine leakage

Question 18

stretch receptors are only found in the bladder, true or flase

Answer 18

false

found in other organs where they monitor the state of the muscle and return the information to the central nervous system.

Question 19

the detrusor muscle is stimulated by??

Answer 19

cholinergic nerves which release ACh for contraction

adrenergic nerves which release NA and A for relaxation

NANC nerves

Question 20

beta 3 adrenergic receptor function

they primary locations it can be found in

Answer 20

primarily involved in regulating the relaxation of smooth muscle, particularly in the bladder, but also in adipose tissue (fat cells) and the heart

adipose tissues
bladder
heart..etc

part of the Sympathetic nervous system

Question 21

beta 3 adrenergic receptor mechanism of action

Answer 21

activated by NE and to a lesser exteny Epinepherine

when NE binds, it activates adenylyl cyclase enzyme in the cell, which elevates cAMP levels

this activates pKA , leading to smooth muscle relaxation

in the bladder this leads to detrusor muscle relaxation

beta-3 adrenergic agonists (such as mirabegron) are used to treat conditions like overactive bladder (OAB).

Question 22

the function of alpha 1 adrenergic receptors in the bladder

Answer 22

When alpha-1 receptors are activated (by sympathetic stimulation), the internal sphincter contracts, maintaining continence by keeping the urethra closed.

they are primarily located on the internal urethral sphincters

Question 23

during the filling stage, the urethral sphicters are closed, true or false

Answer 23

true

to prevent urine leakage from the kidneys into the bladder or from the bladder into the urethra

Question 24

the neurotransmitter that causes Alpha 1 adrenoreceptor activation?

Answer 24

NE primarily(referred to as the sympathetic stimulation of the receptor)

E can also activate these receptors but it is elss prominent in bladder function

the same applies to beta 3 adrenergic receptors on the detrusor muscle

Question 25

neurotransmitter released by the parasympathetic nervous system during the emptying stage of micturition.
the mechanism of action of this neurotransmitter?

Answer 25

ACh

firstly, ACh release causes Internal sphincter relaxation, as it inhibits A1 adrenoreceptors activation.

This relaxation effect is further enhanced by NANC nerve secretions, like NO which also has a relaxing effect.

The parasympathetic nervous system releases acetylcholine (ACh), which binds to muscarinic receptors on the detrusor muscle (mainly M3 receptors), leading to muscle contraction.

This contraction increases the pressure within the bladder, facilitating the expulsion of urine through the relaxed sphincters.

Question 26

micturition reflex can be inhibited until it is deemed convenient to urinate by a person, true or false?

Answer 26

true

Question 27

name some urological disorders

Answer 27

Overactive bladder syndrome (OABS)
Urinary tract infection (UTI)
nocturnal uresis
urinary incontinence
Benign prostatic hyperplasia (BPH)
Cystitis

Question 28

incontinence

types?

Answer 28

Involuntary leakage of urine from the bladder

stress incontinence
urge incontinence
overflow incontinence

most common type is stress incontinence

Question 29

describe the different types of incontinence

Answer 29

stress- caused by weak pelvic floor muscles or a weakened bladder neck, which can lead to urine leakage during physical activity, coughing, sneezing, laughing, or lifting heavy objects. involuntary

urge- characterized by a sudden and intense need to urinate that’s difficult to control

overflow- occurs when small amounts of urine leak from a bladder that’s always full, or when the bladder doesnt empty properly. prevalent in men

incontinence more common in older women because their pelvic floor might have been weakened by factors like pregnancy, childbirth, aging, or obesity…etc

Question 30

name some treatment options for incontinence

Answer 30

adopting techniques to reduce risk factors

non surgical treatments

surgical treatments if required

some risk factors of incontinence include age, gender, weight, smoking, certain meds..etc

Question 31

some examples of non surgical treatments for incontinence

Answer 31

pelvic floor muscle training
pelvic floor physical therapy
incontinence pessary (for female stress urinary incontinence)

A pessary provides gentle compression of the urethra against the pubic bone, which can help prevent or reduce leakage when intra-abdominal pressure increases. This can help with leaks during activities like coughing, exercising, or sneezing

Question 32

examples of surgical treatment methods for incontinence (how they work)

Answer 32

urethral bulking: involves injecting a bulking agent (such as collagen or silicone) into the tissues around the urethra to help it close more effectively and prevent urine leakage, primarily used to treat stress incontinence

male sling: A synthetic sling is placed around the urethra to provide support, helping to control urine leakage during activities like coughing, sneezing, or exercise.

retropubic suspension: involves suturing the bladder neck or urethra to the pubic bone or pelvic ligaments to provide more support and prevent urine leakage, commonly used for female stress incontinence

Male slings and retropubic suspensions generally offer long-term or permanent solutions, though there is always a small risk of complications or failure over time.

Urethral bulking requires maintenance with repeat treatments, as the bulking material may degrade and lose effectiveness over time.

Question 33

symptoms of overactive bladder syndrome

Answer 33

nocturia (more than 2 times nightly)
urge incontinence
increased frequency in urination (i.e more than 8 times daily)
urgency

nocturia refers to the sudden urge to wake up at night to void one’s bladder one or more times

Question 34

some of the negative effects of incontinence

Answer 34

anxiety
Depression and other psycological effects
Reduced quality of life
Huge burden on the NHS
social effects
sexual effects
occupational effects…etc

Question 35

the causes of incontinence are complex and well understood, true or false

Answer 35

false, they are complex but not well understood

Question 36

they two main hypothesis believed to cause OABS

Answer 36

myogenic hypothesis: focuses on muscle dysfunction or changes in the bladder muscle itself, causing abnormal contractions that lead to OAB symptoms

neurogenic hypothesis: focuses on nerve signaling dysfunction, leading to inappropriate sensations of urgency and bladder contractions.

Question 37

how could we diagnose OABS

Answer 37

**Take a detailed history and ask about symptoms (urgency, frequency, urge incontinence).

**Use a bladder diary to assess urinary patterns.

Conduct urodynamic testing if necessary for more complex cases

video urodynamics

Consider cystoscopy or further imaging if there are signs of structural abnormalities

A cystoscopy is a procedure that allows a medical professional to examine the inside of the bladder and urinary tract using a cystoscope, a thin, flexible tube with a camera and ligh

Question 38

urodynamic testing and how it works

i do not need to know this by heart

Answer 38

A group of tests that evaluate how well the bladder and sphincters are storing urine

A catheter is inserted into the bladder through the urethra to fill the bladder with sterile water or saline. This allows measurement of the bladder’s compliance (how well the bladder stretches) and the presence of any involuntary bladder contractions

The patient is asked to simulate normal voiding or hold their urine to test bladder capacity and responsiveness

After urination, a catheter or ultrasound is used to measure the amount of urine remaining in the bladder.

both bladder pressure and urine flow rates are measured during urination, helping to identify whether there is an obstruction or abnormal pressure that could cause symptoms like urinary retention or incontinence.

Small electrodes are placed near the anus or the pelvic floor to measure the electrical activity of the pelvic floor muscles during urination, helping to assess any issues with the coordination between bladder and sphincter muscles. this only happens in certain cases

Question 39

pharmacological treatments for OABS

Answer 39

recommending behavioural modification
Antimuscarinics
Beta 3 adrenoreceptor agonist
Botulinum neurotoxin A