Micturition Flashcards
Where does sensory feedback from the brain regarding whether or not its socially acceptable to urinate travel along
Pelvic nerves
What are the roots of the pelvic nerves
S2,3,4
Where does micturation centre send impulses if it is socially acceptable to urinate
Through pudendal nerve to sphincter
2 things that the bladder does
Emptying and storage
What happens to the bladder during bladder villing
Relaxed detrusor
Urethra contracted
Pelvic floor contracted
What happens during the emptying phase to the bladder
Detrusor contracts
Urethra relaxes
Pelvic floor relaxes
How many times does the average adult wee per day
4
How much urine is passed a day
1500ml
What causes normal bladder contraction
Ach released from cholinergic nerves
Stimulates muscarinic receptors on the detrusor smooth muscle
What are the receptor abnormalities seen in a ‘weak’ bladder
Receptors are not upregulated
What is the problem with a small thickened bladder
High pressure during storage phase which can transmit up to kidneys killing them
2 categories of lower urinary tract symptoms
- Storage symptoms
- Voiding symptoms
Some examples of storage symptoms (lower urinary tract)
Frequency
Nocturia
Urgency
Urge incontinence
Some examples of voiding/ obstructive symptoms
Hesistancy, straining, poor floow, intermittency, incomplete emptying, terminal dribbling, haematuria
What is overactive bladder syndrome
Urgency, with or without incontinence, usually with frequency and nocturia
Define nocturia
Excessive urination at night
What are the values for mild symptoms on IPSS
0-7
What are values for medium and severe symptoms on IPSS
8-19
20-35
Are men or women more affected by urine problem
Both
What investigations can be done in patients with urine problems
- Inspect fresh urine sample
- Dipstick
- FBC
Uroflowmetry and post void residual volume - Urodynamics
- XB KUB
- Ultrasound
- CT KUB
- Nuclear imaging
What problems with ‘outlet’ can occur
Bladder neck problems Prostate problems Stricture Meatus Foreskin tightening
What problems with the pump can occur
Bladder- OAB, sensory, failure
Cardiac
Medication
What problems with the constituents can occur
UTI
Cancer
Inflammation
Stones
How does caffeine make your bladder act
Releases calcium stores from the golgi apparatus in the bladder wall
Makes bladder contraction more likely
How long does the bladder store urine for
3-4 hours
Give some examples of medical therapy for urine problems
Alpha blockers (stretchers)
5-alpha reductase inhibitors (shrinkers)
PDE5 inhibitors
Antimuscarinics
What is the gold standard for surgery
TURP
This is when electric loop carves out prostate chips
What are the risk factors of TURP
- 1:10 need blood transfusion
- Electrolyte problems afer
- 5% chance of affecting erections
What is HoLep?
Modern laser operation
Better at tissue removal
What are the pros of HoLeps
Lesser risk of transfusion, electrolyte probs, erection probs
What is a urolift
Newest technique, stapling prostate back
What is stress urinary incontinence
Leakage on effort or exersion
What is urge incontinence
Leakage accompanied by urgency
How does the bladder/ muscles behave in stress incontinence
Cough/ strain
Pressure doesn’t go around the bladder as it should but forces bladder down
How does bladder/ muscles behave in urge incontinence
No problem with support, but overactive waves
Easy to force urine through and out
What conservative measures can be taken to treat urinary problems
Fluid intake
Caffeine
Pads
Timed voiding
What are the three main classes of medication for OAB/ urge incontinence
- Anticholinergenics
- B3 adrenergenics
- Botulum toxin A
Give examples of anticholingeric drugs used to treat OAB/ urge incontinence
Oxybutymin
Solifenacin
Tolterodine
Fesoterodine
How do anticholinergic drugs work to treat OAB/ urge incontinence
Block acetyl choline in parasympathetic nerves but can also block elsewhere (salivary glands)
How do beta adrenergic drugs work
B3 adrenoceptors upregulated in OAB
Hypertension may be an issue
How do botulumin toxin A work
Fuses with synaptic vesicles in motor end plate
Issues with hypercontinence
Do lesions above the pontine micturition cause problems
No- they are safe
Are lesions below T12 safe or unsafe in terms of urination
Bladder doesn’t squeeze well but sphincter works so you dribble out- safe
In between pontine micturition centre and T12 safe or nto?
UNsafe
Uncooridated so high pressures in the restting bladder
