Jan23 M1-VUR, Enuresis and Bladder Dysfunction Flashcards
SS innervation to the bladder and effect
Hypogastric nerve. inhibits detrusor muscle
PSS innervation to the bladder and effect
pelvic nerve. contrats the detrusor muscle
internal sphincter: type of muscle and innervation
SM
hypogastric nerve. closes it (ANS, involuntary)
external sphincter; type of muscle and innervation
striated
pudendal nerve. closes it (voluntary control)
dev of urinary control
initially spinal reflexes (bladder distension causes bladder contraction).
then higher cortical centers start to control it too and adult pattern assumed by age 4-5
adult pattern of voiding
conscious control of detrusor contraction and external sphincter relaxation
incontinence def
leakage during the day
signs of voiding dysfunction in kids
- urgency
- frequency (increased or decreased)
- nocturia
what can be a cause of weak stream
posterior urethral valves (congenital disease)
intermittent stream: in who is it normal
kids under 3
holding maneuvers def (seen in kids)
behaviors used to postpone voiding (urgency-standing on tiptoe, crossing the legs, squatting,..)
postmicturition dribbling def
leaking (unvoluntary) after micturition
etiologies of bladder dysfct in children (3)
neurogenic, anatomic, functional
neurogenic causes of bladder dysfct in kids
myelomeingocele, trauma to CNS
anatomic causes of bladder dysfct in kids
- ureter insertion distal to the bladder neck
- bladder outlet obsruction (posterior urethral valves, polyuria from renal failure)
functional causes of bladder dysfct in kids
(no anat or neuro cause)
- maturation delay
- infantile bladder behavior
- abnormal toilet habits
ectopic ureter pathophgy
2nd ureteric bud came off to form a third kidney and this bud inserts below the external sphincter
EUI in boys
usually above external sphincter (no dribbling). may get UTI or prostatitis. epididym infection if inserts in other tract
EUI in girls
more frequent in girls. small drops (dribbling) coming out of urethra
why don’t we pee at night normally
ADH is on
questions to evaluate for bladder dysfunction
- growth
- voiding schedule
- polydipsia
- bowel habits
useful thing to do to evaluate for bladder dysfct
ask for 3 day history of voiding and drinking + bowel diary. qtfy everything
why voiding related to stooling
when you’re constipated, it pushes on the bladder so it doesn’t empty completely
2 normal poo shapes and type on the poo scale
type 4: sausage
type 5: chicken nuggets
physical exam of bladder dysfct in kids
- height and weight + percentile
- BP (htn = renal disease)
- neuro (normal reflexes, strength, walking)
- fecal or urinary staining-palpable bladder
- external genital exam (skin irritation, urethral meatus, gluteal cleft)
- psychosocial attitude towards the exam
labs investigations in kids with bladder dysfct
UA and micro U culture lytes blood gas BUN/Cr
radiological investigations in kids with bladder dysfct
- lumbosacral spine
- pain abdominal films
- US
- voiding cystourethogram
bladder dysfct in kids: when to refer to urology or neurology
- genital exam abnormal
- lumbosacral spine prob
- neuro exam abnormal
- total urinary incontinence
Vesico-ureteric reflex (VUR) def
congenital defect of how ureter attaches to the bladder
VUR associated with what
malformations, recurrent UTIs, kidney damage, htn
VUR treatment
antibiotics + surgery
characteristics of uretero-vesical junction (VUR)
- short intravesical ureter
- enlarged ureteral orifice
- ectopic ureteral orifice
- inadequate ureteral SM
non pharma treatment for kids with voiding dysfct
time voiding
double voiding
how to treat type 1-2-3 of poop (hard)
- more dietary fiber
- laxatives
