Micturition

Question 1

What is responsible for continence ?

Answer 1

Intrinsic sphincter - bladder neck muscle fibers mid-urethral (membrane/prostate in males) complex

Question 2

What interrupts stream?

Answer 2

rhabdosphincter

Question 3

Parasympathetic innervation (Pelvic nerve s2-4)

Answer 3

Detrusor muscle - micturition upon contraction

Question 4

Motor innervation (CNS)

Answer 4

bladder, pelvic floor, urethral sphincter (s2-4) - sensation of bladder fullness or stretch are conveyed through long neurons from spinal cord to pons

Question 5

Sympathetic (ANS)

Answer 5

T10-L2 = Inhibits detrusor and increases tension in the smooth muscle of the bladder neck and proximal urethra

Question 6

Higher order control

Answer 6

Cortex - inhibitory over sacral centers (think disease and incontinence / stroke)

Cerebellum/Brainstem - facilitory

Question 7

Root with motor

Answer 7

ventral

Question 8

Root with sensory

Answer 8

dorsal

Question 9

Dysfunction of bladder storage phase (normally neuromuscular adaption allows minimal pressure change with increased volume) — dysfunction

Answer 9

frequency, urgency, and urge incontinence - OAB

Question 10

Storage phase

Answer 10

allows bladder to adapt to increasing volume with little changes in pressure (affarent pelvic nerve fibers to DRG) (Efferent pudendal via VH - inhibit detrusor - somatic and cortical)

Question 11

What causes detrusor contraction

Answer 11

PS of pelvic nerve

Question 12

2 functions of bladder

Answer 12

store and empty urine

Question 13

Urine empty must override storage - dysfunction

Answer 13

hesitancy / weak stream / incomplete empty

Question 14

5 steps of bladder emptying

Answer 14

increase in bladder wall tension

affarent input overcomes pontine micturition center threshold and povides cortical egress micturition begin

pudendal nerve (SMN) activity ceases (relax), the external sphincter and pelvic floor relaxes (SN), detrusor neurons (PS) are freed and discharge

proxmial urethra opens

bladder immediately contracts

Question 15

micturition cycle dysfunction

Answer 15

hesitancy / weak stream / retention

Question 16

efferent response to bladder filling?

Answer 16

pudendal s2-s4 (somatic) - associated with cortical inhibition of detrusor

Question 17

step 1 voiding?

Answer 17

increase wall tension in bladder

Question 18

Step 2 voiding (After increase in wall tension)

Answer 18

affarent input overcomes the pontine micturition center threshold and provides cortical egress –> micturition begins

Question 19

step 3 voiding (After cortical egress initiates micturition)

Answer 19

1. pudendal (SMN) relax
2. External sphincter/pelvic floor relax (SM)
3. Detrusor (PS) freed from inhibition

Question 20

Step 4 voiding (after inhibition ceases)

Answer 20

proximal urethra opens

Question 21

step 5 voiding (after urethra opens)?

Answer 21

bladder contracts

Question 22

what monitors bladder?

Answer 22

pelvic nerve affarents

Question 23

somatic pudendal nerves?

Answer 23

constrict urethral sphincter

Question 24

lumbar sympathetic nerves

Answer 24

inhibit bladder

constrict sphincter

Question 25

pelvic PS nerves

Answer 25

contract blader | inhibit sphincter contraction

Question 26

2 main causes of incontinence

Answer 26

stress | urge

Question 27

OAB (urge) usually due to?

Answer 27

neurological problem | treat with Anticholinergics

Question 28

drug for OAB

Answer 28

Oxybutynin CytP450 3A4 Dries you out

Question 29

involuntary sudden loss of urine during increases in intra abdominal pressure

Answer 29

Stress incontinence

Question 30

Treat stress incontinence with?

Answer 30

ephedrine | estrogen

Question 31

UTO most common in men?

Answer 31

BPH

Question 32

BPH symptoms UTO

Answer 32

Frequency / urgency / | Hesitancy / decreased stream

Question 33

Storage issues

Answer 33

frequency urgency

Question 34

emptying issues

Answer 34

hesitancy straining weak stream

Question 35

% 80 year olds with BPH

Answer 35

80 | 50% with symptoms

Question 36

% 50 year olds with BPH

Answer 36

25%

Question 37

Treat BPH?

Answer 37

5-alpha reductase inhibitor alpha1 blocker combo surgery

Question 38

Young Men UTO

Answer 38

Urethral stricture often from trauma

Question 39

PS NERVE

Answer 39

pelvic (bladder)

Question 40

Sympathetic Nerve

Answer 40

Hypogastric (T10-L2) | detrusor / urethra / bladder neck

Question 41

Motor (Somatic) Nerve

Answer 41

Pelvic pelvic floor external sphincter