Micturition Flashcards
What structures lie between the bladder and the rectum?
Vasa deferentia + Seminal Vesicle
OR
Cervix + Upper Vagina
How much is the volume of full bladder (ml)?
500 ml
pubovesical/Puboprostatic ligament
- pubovesical ligament extends from the neck of the bladder on the inferior aspect of the pubis bones
- anterior stabilization of the urinary continence mechanism
What is the urachus, and what is it’s destiny?
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.
Peritoneum covers the _____ surface of the bladder
Superior
What is trigone?
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.
What forms the musculature of the bladder?
The musculature of the bladder neck is formed by the trigonal detrusor and urethral musculature.
Any specific names for the sphincters of urethra?
Lissosphincter: distinct from detrusor muscle/ SMM;
Rhabdospincter: SKM; Slowe-twitch fibers
What structures contribute to the urinary bladder compliance.
Suburothelium -> a zone of loose connective tissue with delicate angiolymphatic vessels
umbrella cells are a component of the ____ Layer of the ______
Apical layer of Urothelium
What kinds of afferent nerve fibers are present in muscularis propria?
a. A alpha
b. A beta
c. A gamma
d. A delta
d. A delta
Which sensory fibers are thought to be activated in normal micturition reflex?
Visceral small Aδ afferent fibers predominantly contribute to the normal micturition reflex.
fibers found in the urothelial and suburothelial layers, respond to mechanical and chemical stimuli, high threshold, transmit pain.
Unmyelinated C fibers
What is another name for urothelium?
Urinary Endothelium
What is the most common type of urinary bladder cancer?
Urothelial Carcinoma
How deep can the invasion go into the bladder wall?
to other contiguous organs
Tx of choice for muscularis propria invasion of carcinoma in the bladder
Cystectomy
Which of the following include efferent pathway of nerve fibers without ganglia?
a. hypogastric
b. pelvic
c. pudendal
d. sacral
C. Pudendal
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
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.
Drug Types for Urinary Bladder
- Cholinergic: help empty bladder
- Alpha-adrenergics: tighten intern sphincter muscles
- Anti-cholinergics: Relax bladder to hold more urine + DEC need for frequ urination
