Bladder Problems

Question 1

Basic anatomy of the bladder

Answer 1

Found in the pelvic cavity when empty - expands into abdominal cavity when it becomes full
Made up of 4 parts - apex, base, superior surface and inferolateral surfaces

trigone = smooth triangular area between the openings of the ureters and urethra on inside of bladder

urethra = shorter in F so more likely to get infected

Question 2

3 efferent nerve supplies to bladder and role of efferent supply

Answer 2

1. Sympathetic (hypogastric nerve)
2. Parasympathetic (pelvic nerve)
3. Somatic (pudendal nerve)

= regulation of continence and micturition

Question 3

Role of sympathetic (hypogastric) nerve

Answer 3

Perception of pain sensation from urethra and bladder

Question 4

Role of parasympathetic (pelvic) nerve

Answer 4

Reflex micturition and sensation of bladder fullness

Question 5

Role of somatic (pudendal) nerve

Answer 5

Sensation of passage of urine through urethra

Maintains tonic contractions of skeletal muscle fibres of the external sphincter Sensation of distention of urethra

Question 6

Favourable conditions in neurogenic control of micturition

Answer 6

• contraction of anterior abdominal muscle and diaphragm to increase intra-abdominal pressure
• stimulation of sacral micturition centre
• voiding under parasympathetic (pelvic nerve) regulation
• inhibition of somatic (pudendal) nerves = relaxation of external urethral sphincter

Question 7

Unfavourable conditions in neurogenic control of micturition

Answer 7

• inhibition of micturition reflux
• inhibition of sacral micturition centre
• holding of urine under sympathetic (hypogastric nerve) regulation
• stimulation of somatic (pudendal) nerves = contraction of external urethral sphincter

Question 8

Cystometrogram

Answer 8

= plot of intravesical pressure (pressure in bladder) against volume

Question 9

atonic/hypotonic bladder

Answer 9

Destruction of sensory nerve fibres from bladder.

Bladder loses tone and becomes flaccid

Question 10

treatment of atonic/hypotonic bladder

Answer 10

Anticholinesterases - treats neurogenic problems to increase detrusor contraction

Antimuscarinics - enhance contraction of bladder smooth muscle

Bladder catheterisation

Question 11

Automatic bladder

Answer 11

bladder loses tone and becomes flaccid and unresponsive
whenever bladder filled with some amount of urine = automatic evacuation of bladder

caused by spinal shock - 2-6 weeks for shock to pass

Question 12

Uninhibited neurogenic bladder

Answer 12

= uncontrollable micturition

caused by lesions in some parts of brain stem = continuous excitation of spinal micturition centres by higher centres

Question 13

Nocturnal micturition (bed wetting)

Answer 13

caused by incomplete myelination of motor nerve fibres of bladder
= loss of voluntary control of micturition

Question 14

Symptoms and causes of overactive bladder

Answer 14

Symptoms: frequency and urge incontinence, urinary urgency and nocturia

Causes: stroke, spinal injury, MS, detrusor instability and meds (ACEi, opioids, diuretics, antipsychotics)

Question 15

Treatment of overactive bladder

Answer 15

ADH synthetic analogue
change in lifestyle (more fluids in morn and avoid alcohol/caffeine)
muscarinic receptor antagonist
beta3-adrenoreceptor antagonist
topical vaginal oestrogen-replacement therapy

Question 16

Urethral sphincter incompetence (inc. causes and consequences)

Answer 16

= dribbling and/or continuous leakage from incomplete bladder emptying

caused by impaired detrusor contractility and/or bladder outlet obstruction

produces: sphincter weakness in men and stress incontinence in women

Question 17

treatment for urethral sphincter incompetence

Answer 17

anti-incontinence devices
alpha1-adrenoreceptor antagonists (SE may make it worse)
physical therapy (pelvic floor muscle training)

Question 18

Painful bladder syndrome (PBS)/ Interstitial cystitis (IC) and causes

Answer 18

= bladder pain of variable sensitivity

caused by: urothelial abnormalities, altered bladder epithelial expression of HLA class I and II antigens, altered integrity of glucosaminoglycon (GAG) layer

Question 19

types of over-active bladder (OAB)

Answer 19

Urinary frequency - perceived urination too often during the day (>8)
Urgency - sudden compelling desire to urinate w/ difficulty to delay
Enuresis - involuntary urination at night
Nocturia - woken at least once during sleep to pee

Question 20

when to refer women with urinary incontinence

Answer 20

previous continence surgery 
suspected urogenital fistulae 
persisting pain 
benign pelvic mass 
palpable bladder 
symptoms of voiding difficulty

Question 21

Risk factors for urinary incontinence in women

Answer 21

number of children 
age 
poor obstetric care 
co-morbidities (T2D, chronic UTIs) 
overweight 
post-menopausal changes

Question 22

Causes of LUTS in men

Answer 22

drugs 
injury to urethral area 
infection 
cancer 
neurological conditions 
BPH = common cause

Question 23

treatment options for OAB

Answer 23

anticholinergics, selective beta3 agonist (Mirabegron), desmopressin (nocturia in women), duloxetine (antidepressant)

Question 24

drugs that can induce acute urinary retention

Answer 24

Drugs with significant antimuscarinic action:

atropine, tricyclic antidepressants, sedative antihistamines, some antipsychotics