Chapter 24 Neurogenic Bladder

Question 1

What level of the spine is responsible for the “sacral micturition center”?

Answer 1

S2-4

Question 2

What level of the spine is responsible for the “sympathetic efferents”? What is the name of the nerve?

Answer 2

arising from ≈T10-L2, hypogastric nerve

Question 3

What level of the spine is responsible for the “somatic efferents? What is the name of the nerve?

Answer 3

Onuf’s nucleus, S2-4, pudendal nerve

Question 4

What level of the spine is responsible for the “parasympathetic efferents? What is the name of the nerve?

Answer 4

S2-4, sacral micturition center, traveling in the pelvic nerves

Question 5

Describe the normal Neurophysiology of bladder distention.

Answer 5

Bladder distention activates detrusor stretch (δ) receptors, which in turn activate the sacral micturition center at S2-4. During bladder filling, the intact cerebral cortex inhibits the sacral micturition center and reflex bladder contraction. Also, sympathetic efferents (arising from ≈T10-L2, hypogastric nerve) stimulate fundal β-receptors (relaxation) and trigonal/bladder neck α-receptors (contraction), the overall effect of which is storage. (Mnemonic: sympathetic is for storage; parasympathetic is for peeing.) Voluntary continence is maintained via somatic efferents (Onuf’s nucleus, S2-4, pudendal nerve), which innervate the external urethral sphincter.
With voiding, urethral sphincter pressure drops and the detrusor contracts (stimulated by parasympathetic fibers from the sacral micturition center, traveling in the pelvic nerves).

Question 6

The first sensation of bladder filling is typically at what amount of urine? At what volume is fullness appreciated?

Answer 6

≈100 mL. Fullness may be appreciated at ≈300 to 400 mL.

Question 7

The synergic interaction between sphincter and detrusor is coordinated by what center?

Answer 7

the pontine micturition center

Question 8

A suprapontine (i.e., TBI and stroke) lesion can cause _______, w/o _______.

Answer 8

A suprapontine (i.e., TBI and stroke) lesion can cause detrusor hyperreflexia, w/o detrusor–sphincter dyssynergia (DSD).

Question 9

What are the SX of TBI/Stroke Neurogenic Bladder?

Answer 9

Symptoms can include frequency and incontinence (“failure to store”).

Question 10

Name 3 TX options for TBI/Stroke suprapontine lesion Neurogenic Bladder.

Answer 10

Treatment options may include timed voids (i.e., offer bedpan q2h), urinary collection devices (i.e., condom catheter), or anticholinergics (e.g., oxybutynin).

Question 11

A suprasacral SCI can cause ________, which is characterized by________.

Answer 11

A suprasacral SCI can cause DSD, which is characterized by the lack of sphincter relaxation during bladder contraction.

Question 12

What are SX of SCI Neurogenic Bladder?

Answer 12

This may manifest as urinary retention (“failure to empty”) and eventually result in vesicoureteral reflux due to high bladder contraction pressures.

Question 13

Name 3 TX options for suprasacral SCI Neurogenic Bladder.

Answer 13

Treatment options include clean intermittent catheterization (CIC) (e.g., volumes 400 to 500) and oral or intravesical anticholinergics (e.g., capsaicin and resiniferatoxin), α-adrenergic blockers, indwelling catheterization, stent placement, sphincterotomy, sphincter botulinum injection, or neuro-stimulation.

Question 14

A sacral or peripheral nerve lesion can cause _________, which may manifest as _________.

Answer 14

A sacral or peripheral nerve lesion can cause detrusor areflexia, which may manifest as retention or overflow incontinence.

Question 15

Name 3 TX options for sacral or peripheral nerve lesion detrusor areflexia.

Answer 15

Treatment options may include Valsalva maneuver, suprapubic pressure (Crede) or percussion, cholinergic agonists (e.g., bethanechol), CIC, or indwelling catheter

Question 16

Bladder Neurophysiology – Bladder distention activates ___________ stretch (δ) receptors, which in turn activate the ___________ ___________ center at S2-4. During bladder filling, the intact cerebral cortex inhibits the sacral micturition center and reflex bladder contraction. Also, sympathetic efferents (arising from ≈T10-L2, hypogastric nerve) stimulate fundal β-receptors (relaxation) and trigonal/bladder neck α-receptors (contraction), the overall effect of which is storage. (Mnemonic: sympathetic is for storage; parasympathetic is for peeing.)

Answer 16

Bladder Neurophysiology – Bladder distention activates detrusor stretch (δ) receptors, which in turn activate the sacral micturition center at S2-4. During bladder filling, the intact cerebral cortex inhibits the sacral micturition center and reflex bladder contraction. Also, sympathetic efferents (arising from ≈T10-L2, hypogastric nerve) stimulate fundal β-receptors (relaxation) and trigonal/bladder neck α-receptors (contraction), the overall effect of which is storage. (Mnemonic: sympathetic is for storage; parasympathetic is for peeing.)

Question 17

Bladder Neurophysiology
The first sensation of bladder filling is typically at ≈___________ mL. Fullness may be appreciated at ≈___________ to ___________ mL. Voluntary continence is maintained via somatic efferents (Onuf’s nucleus, S2-4, pudendal nerve), which innervate the external urethral sphincter.

Answer 17

Bladder Neurophysiology
The first sensation of bladder filling is typically at ≈100 mL. Fullness may be appreciated at ≈300 to 400 mL. Voluntary continence is maintained via somatic efferents (Onuf’s nucleus, S2-4, pudendal nerve), which innervate the external urethral sphincter.

Question 18

Bladder Neurophysiology
With voiding, urethral sphincter pressure drops and the detrusor contracts (stimulated by parasympathetic fibers from the sacral micturition center, traveling in the pelvic nerves). This synergic interaction between sphincter and detrusor is coordinated by the ___________ micturition center (Fig. 24-1).

Answer 18

Bladder Neurophysiology
With voiding, urethral sphincter pressure drops and the detrusor contracts (stimulated by parasympathetic fibers from the sacral micturition center, traveling in the pelvic nerves). This synergic interaction between sphincter and detrusor is coordinated by the pontine micturition center (Fig. 24-1).

Question 19

Neurogenic Bladder – A ___________ (i.e., TBI and stroke) lesion can cause detrusor ___________, w/o detrusor–sphincter dyssynergia (DSD). Symptoms can include frequency and incontinence (“failure to store”). Treatment options may include timed voids (i.e., offer bedpan q2h), urinary collection devices (i.e., condom catheter), or anticholinergics (e.g., oxybutynin).

Answer 19

Neurogenic Bladder – A suprapontine (i.e., TBI and stroke) lesion can cause detrusor hyperreflexia, w/o detrusor–sphincter dyssynergia (DSD). Symptoms can include frequency and incontinence (“failure to store”). Treatment options may include timed voids (i.e., offer bedpan q2h), urinary collection devices (i.e., condom catheter), or anticholinergics (e.g., oxybutynin).

Question 20

Neurogenic Bladder
A ___________ SCI can cause DSD, which is characterized by the lack of sphincter relaxation during bladder contraction. This may manifest as urinary retention (“failure to empty”) and eventually result in vesicoureteral reflux due to high bladder contraction pressures. Treatment options include clean intermittent catheterization (CIC) (e.g., volumes 400 to 500) and oral or intravesical anticholinergics (e.g., capsaicin and resiniferatoxin), α-adrenergic blockers, indwelling catheterization, stent placement, sphincterotomy, sphincter botulinum injection, or neuro-stimulation.

Answer 20

Neurogenic Bladder
A suprasacral SCI can cause DSD, which is characterized by the lack of sphincter relaxation during bladder contraction. This may manifest as urinary retention (“failure to empty”) and eventually result in vesicoureteral reflux due to high bladder contraction pressures. Treatment options include clean intermittent catheterization (CIC) (e.g., volumes 400 to 500) and oral or intravesical anticholinergics (e.g., capsaicin and resiniferatoxin), α-adrenergic blockers, indwelling catheterization, stent placement, sphincterotomy, sphincter botulinum injection, or neuro-stimulation.

Question 21

Neurogenic Bladder
A sacral or peripheral nerve lesion can cause detrusor ___________, which may manifest as retention or overflow incontinence. Treatment options may include Valsalva maneuver, suprapubic pressure (Crede) or percussion, cholinergic agonists (e.g., bethanechol), CIC, or indwelling catheter.

Answer 21

Neurogenic Bladder
A sacral or peripheral nerve lesion can cause detrusor areflexia, which may manifest as retention or overflow incontinence. Treatment options may include Valsalva maneuver, suprapubic pressure (Crede) or percussion, cholinergic agonists (e.g., bethanechol), CIC, or indwelling catheter.