Micturition

Question 1

What structures lie between the bladder and the rectum?

Answer 1

Vasa deferentia + Seminal Vesicle
OR
Cervix + Upper Vagina

Question 2

How much is the volume of full bladder (ml)?

Answer 2

500 ml

Question 3

pubovesical/Puboprostatic ligament

Answer 3

• pubovesical ligament extends from the neck of the bladder on the inferior aspect of the pubis bones
• anterior stabilization of the urinary continence mechanism

Question 4

What is the urachus, and what is it’s destiny?

Answer 4

The urachus is a fibrous remnant of the allantois, a canal that drains the urinary bladder of the fetus that joins and runs within the umbilical cord and forms the median umbilical ligament after birth.

Question 5

Peritoneum covers the _____ surface of the bladder

Answer 5

Superior

Question 6

What is trigone?

Answer 6

The trigone is a triangular region located at the base of the bladder between the ureteric orifices superolaterally and the opening of the urethra inferiorly. Developmentally, the trigone is derived from the distal ureters and incorporated into the bladder wall.

Question 7

What forms the musculature of the bladder?

Answer 7

The musculature of the bladder neck is formed by the trigonal detrusor and urethral musculature.

Question 8

Any specific names for the sphincters of urethra?

Answer 8

Lissosphincter: distinct from detrusor muscle/ SMM;

Rhabdospincter: SKM; Slowe-twitch fibers

Question 9

What structures contribute to the urinary bladder compliance.

Answer 9

Suburothelium -> a zone of loose connective tissue with delicate angiolymphatic vessels

Question 10

umbrella cells are a component of the ____ Layer of the ______

Answer 10

Apical layer of Urothelium

Question 11

What kinds of afferent nerve fibers are present in muscularis propria?

a. A alpha
b. A beta
c. A gamma
d. A delta

Answer 11

d. A delta

Question 12

Which sensory fibers are thought to be activated in normal micturition reflex?

Answer 12

Visceral small Aδ afferent fibers predominantly contribute to the normal micturition reflex.

Question 13

fibers found in the urothelial and suburothelial layers, respond to mechanical and chemical stimuli, high threshold, transmit pain.

Answer 13

Unmyelinated C fibers

Question 14

What is another name for urothelium?

Answer 14

Urinary Endothelium

Question 15

What is the most common type of urinary bladder cancer?

Answer 15

Urothelial Carcinoma

Question 16

How deep can the invasion go into the bladder wall?

Answer 16

to other contiguous organs

Question 17

Tx of choice for muscularis propria invasion of carcinoma in the bladder

Answer 17

Cystectomy

Question 18

Which of the following include efferent pathway of nerve fibers without ganglia?

a. hypogastric
b. pelvic
c. pudendal
d. sacral

Answer 18

C. Pudendal

Question 19

A 68-year old man is evaluated for urinary incontinence. Five month ago he started to take tamsulosin, α1-adrenoceptor antagonist for occasional nocturiarelated to benign prostatic hyperplasia?. The medication reduced the frequency of nocturia, but the patient continued to have daytime urinary urgency with a few occasions of urine leakage. He tried to control his symptoms with behavioral modifications, including scheduled voiding without significant improvement. He declined any surgical options. His vital signs and physical exam are normal, and medical history is unremarkable. Bladder ultrasonography shows a postvoid residual urine volume of 30 ml (normal < 50 ml).

Which of the following is the most appropriate treatment?
A. Dutasteride, 5 alpha reductase inhibitor
B. Intermittent bladder catherization
C. Sacral nerve root neurostimulation
D. Mirabegron, beta 3 adrenergic receptor agonist

Answer 19

A. Dutasteride, 5 alpha reductase inhibitor

Dutasteride is an inhibitor of the 5-alpha reductase approved for the treatment of benign prostatic hyperplasia. Inhibitors of the 5-alpha reductase enzyme family block the conversion of testosterone to DHT and thus limit prostate stroma growth.

Question 20

Drug Types for Urinary Bladder

Answer 20

1. Cholinergic: help empty bladder
2. Alpha-adrenergics: tighten intern sphincter muscles
3. Anti-cholinergics: Relax bladder to hold more urine + DEC need for frequ urination