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SAM 2 > Micturition Disorders > Flashcards

Micturition Disorders Flashcards

1
Q

What categories are micturition disorders divided into?

A

Neurogenic and non-neurogenic

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2
Q

What are some common micturition disorders?

A 
UMN bladder (spastic/autonomic)
Reflex detrusor- urethral dyssynergia
Detrosor atony
LMN bladder (detrusor and urethral areflexia)
Dysautonomia
Urinary incontinence
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3
Q

What does the parasympathetic nervous system control in the bladder?

A

Causes the bladder to contract (bladder emptying)

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4
Q

What does the sympathetic nervous system control in the bladder?

A

Causes the bladder to relax and the internal muscle sphincter to contract (bladder filling)

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5
Q

What does the somatic system control in the bladder?

A

External urethral sphincter contraction (voluntary micturition) and sensory component

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6
Q

What nerve provides parasympathetic innervation to the bladder?

A

Pelvic nerve (S1-3)

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7
Q

What nerve provides sympathetic innervation to the bladder?

A

Hypogastric nerve (dogs L1-4; cats L2-5)

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8
Q

What nerve provides somatic innervation to the bladder?

A

Pudendal nerve (S1-3)

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9
Q

What nerve provides sensory information to the bladder?

A

Pelvic nerve (S1-3)

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10
Q

What controls the passive filling phase or urination?

A

Hypogastric nerve

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11
Q

What controls the active voiding phase of urination?

A

Pelvic nerve and pudendal nerve

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12
Q

T/F: Pudendal nerve control of the external urethral sphincter can be overridden by the cerebrum.

A

True

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13
Q

What nerological effects will an UMN bladder have?

A

Detrusor areflexia with sphincter hyperreflexia

Reflex dyssynergia can also occur

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14
Q

What PE signs are characteristic of an UMN bladder?

A

Small to large distended bladder that is difficult to express and only expels small volumes

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15
Q

What spinal lesion will result in an UMN bladder?

A

Lesions cranial to the sacral segment

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16
Q

What is baclofen?

A

Rx anti-spasmotic that helps UMN bladders by relaxing the skeletal muscle

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17
Q

What neurological effects will a LMN bladder have?

A

Detrusor areflexia and sphincter areflexia

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18
Q

What PE signs are characteristic of an LMN bladder?

A

Large bladder that is easily expressed and may leak constantly

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19
Q

What spinal lesion will result in an LMN bladder?

A

Sacral spinal cord or pelvic segment

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20
Q

What drug is typically prescribed for LMN bladders?

A

Bethenecol

Manual bladder emptying recommended

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21
Q

What is detrusor-sphincter reflex dyssynergia?

A

Initiation of detrusor contraction triggers urethral sphincter spasms

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22
Q

What is the treatment for detrusor-sphincter reflex dyssynergia?

A

Phenoxybenzamine (alpha blockers)

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23
Q

What are lower urinary dysautonomias most common in?

A

Cats- very rare condition with a poor prognosis

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24
Q

What is the typical etiology of detrusor atony?

A

Overfilling of the bladder due to obstruction of UMN dysfunction

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25
Q

What are the clinical signs of detrusor atony?

A

Large flaccid bladder on PE with normal neurological dysfunction

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26
Q

What is the doctor term for urge incontinence?

A

Detrusor instability/hyperreflexia

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27
Q

What is detrusor instability/hyperreflexia?

A

Detrusor contraction during storage phase of urination or low compliance of detrusor muscle

28
Q

How do you confirm detrusor instability/hyperreflexia?

A

Cystometrography

29
Q

What are the clinical signs of urge incontinence?

A

Pollakiuria, stranguria, dysuria

30
Q

What is the treatment for urge incontinence?

A

Anticholinergic drugs- oxybutynin, imipramine, dicyclomine

31
Q

What is urinary incontinence?

A

The involuntary escape of urine during the storage phase of the urinary cycle

32
Q

How does urinary incontinence manifest clinically?

A

Intermittent or continuous dribbling of urine with a normal voiding episode

33
Q

What are the mechanisms of urinary incontinence?

A
  • Intravesicular pressure greater than urethral pressure

Anatomic abnormalities

34
Q

What is the most common etiology of urinary incontinence?

A

Urinary sphincter mechanism incompetence (SMI)

35
Q

What are some differentials of urinary incontinence?

A 
Neurological disease
Ectopic ureters
Vaginal stricture
Pelvic bladder
Ureterocele
Ureterovaginal fistula
36
Q

What kind of neurological condition will result in apparent urinary incontinence?

A

LMN bladder- not TECHNICALLY true urinary incontinence

37
Q

What is a common anatomical abnormality that will present with apparent incontinence?

A

Hooded/recessed vulva- will also see dermatitis and urine scalding

38
Q

What are conditions that will present with apparent incontinence?

A
  • Pollakiuria
  • PU/PD
  • Behavioral issues
39
Q

What are two anatomical abnormalities that can predispose to sphincter mechanism incompetence?

A

Intrapelvic bladder and wide urethra

40
Q

What percentage of true incontinence issues is SMI responsible for?

A

85%

41
Q

What will a clinical examination show in an animals with SMI?

A

Soiled perineal coat with urine scald and anatomical correctness
Neuro exam rules out UMN/LMN dysfunction

42
Q

What will urinary tone depend on?

A

Urethral tone, urethral length, reproductive status

43
Q

What effect does estrogen have on the urethra?

A

Thins the mucosal wall and lower number of alpha-1 receptors

44
Q

T/F: Urinary sphincter incompetence is most commonly reported in male dogs.

A

False- very rarely reported in male dogs

45
Q

What is the typical signalment of a urinary sphincter incompetence patient?

A

Spayed female dog

46
Q

Is the incidence of urinary sphincter incompetence higher in large breed or small breed dogs?

A

Large breed

47
Q

What is estrogen responsive incontinence?

A

Lack on estrogen causing a decrease in sensitivity of the smooth muscle receptor to sympathetic stimulation

48
Q

Will estrogen therapy help with estrogen responsive incontinence?

A

Kinda- 61-65% improval

49
Q

What is the pressure transmission theory?

A

When the urethral neck is not in the abdominal cavity, it is not subjected to the same pressures as the bladder and the bladder pressure will exceed the urethral pressure resulting in leakage of urine

50
Q

What is the hammock theory?

A

In cases where the anatomic structures maintaining the bladder ant he urethra are abnormal
- supporting layers of the urethra are formed by pelvic fascia and suburethral vaginal wall and by distal fixation to pubic bones. During increased abdominal pressure, stabilization occurs and adds tone to the urethra

51
Q

What are the indications for a urethral pressure profile?

A
  1. Urethral sphincter mechanism incompetence
  2. Detrusor instability
  3. Reflex dyssynergia
  4. Neurogenic abnormalities
52
Q

What are some other tests for determining urodynamics?

A

Cystometry and electromyography

53
Q

T/F: Spaying dogs results in decreased urethral pressures typically within 18 months.

A

True- compensatory increase in striated muscle in the cauldal 1/3 of the urethra

54
Q

T/F: Tail docking increases incidence of urinary incontinence.

A

True

55
Q

What is the concern with treating incontinence female dogs with etrogen or estriol?

A

Bone marrow supression/aplasia

56
Q

What is an implantation treatment for urinary incontinence?

A

Implant of bovine collagen into the urethra to increase urethral pressures
- May necessitate repeat procedures

57
Q

What is the typical surgical procedure to correct urinary incontinence?

A

Coposuspension and urethropexy

53% regain continence and 37% improved continence

Complication rate 21%

58
Q

What is the difference in treatment of urinary incontinence with phenylpropanolamine (PPA) and ephedrine?

A

Similar effects to the bladder and overall outcome but ephedrine has more cardiovascular side effects making it a worse choice

Pseudoephedrine has a very poor outcome when compared to PPA and ephedrine treatments

59
Q

Is there a difference in outcome/symptoms between treatment with estriol alone and estriol and PPA combination?

A

No, similar outcomes so long as a singular therapy is not sufficient

60
Q

What is the typical presentation of ectopic ureters?

A

Wet coat, inflamed perineum, excoriation and urine scald

61
Q

How are ectopic ureters diagnosed definitively?

A

Excretory urogram CT and cystoscopy are best

IVP and CT can have false positives

62
Q

What is the typical treatment of choice for ectopic ureters?

A

Cystoscopic laser ablation

63
Q

What will you also see with ectopic ureters on IVP?

A

Hydronephrosis and hydroureter

64
Q

T/F: Ectopic ureters can be hereditary.

A

True- may likely have other developmental anomalies in the urogenital tract

65
Q

What is a common complication of ectopic ureters?

A

Recurrent UTI and pyelonephritis

Need to treat and rid infection before proceeding with surgery to fix ureters

66
Q

What is a complication after surgery to fix ectopic ureters?

A

Urinary Sphincter mechanism incompetence

SAM 2 (21 decks)

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