Micturition Disorders Flashcards
Let’s start slow, the peripheral NS is divided into which groups?
- Autonomic NS (involuntary)
2. Somatic NS (skeletal m- voluntary)
The autonomic NS is divided into parasympathetic and sympathetic. What is the responsibility of each with regards to the bladder?
Parasympathetic: ACh: causes the bladder to contract –> urinate
Sympathetic: Noraadrenalin: causes the bladder to relax –> fill up
-causes the internal m sphincter to contract, keep the bladder full
What is the Somatic NS responsible for with the bladder?
Motor component! ACh causes contraction of the external urethral sphincter
Sensory component
What happens during the passive phase of filling (reservoir)?
Innervated by L1-L4 (hypogastric: sympathetic)
- activate beta receptors to allow stretching - activates alpha 1 receptors of the trigone and proximal urethra - blocks parasympathetic outflow
What happens during the active phase (voiding)?
Reflex: stretch receptors –> pelvic n –> SC –> brain stem –> parasympathetic outflow (pelvic n S1-S3)
Contraction of the bladder wall –> m fibers contract
Pudendal n is inhibited by decreasing urethral sphincter tone
Can be overridden by the cerebrum
I am sitting in class and I have to pee because I always have to pee. I’m holding it in because that’s what’s socially acceptable. What stage am I in?
Active phase: squeezing to hold it in
The following things are associated with UMN bladder or LMN bladder:
- sphincter hyperreflexia
- reflex dyssynergia can also occur
- small volumes of urine
- small bladder
- difficult to express
- lesion about sacral segment
UMN bladder!
How do we tx UMN bladder?
baclofen: anti spasmodic, acts as inhibitory NT, skeletal m relaxant
The following things are associated with UMN bladder or LMN bladder:
- large bladder
- easily expressed
- constantly leaks
- sacral spinal cord segment or pelvic segment lesion
LMN bladder!
How do we tx LMN bladder?
Express bladder 3-4 times/day, bethanecol
How is Detrusor-Sphincter Reflex Dyssynergia initiated and treated?
with initiation of detrusor contraction, the urethral sphincter spasms
tx w alpha adrenergic blockers (phenoxybenzamine)
Is dysautoanomia something we will frequently see in dogs?
No! It is rare but if we do see it, it’s in cats. Poor prognosis
The following things describe what problemo
- occurs from OVERFILL (obstruction)
- large, flaccid bladder
- neurological exam is normal
- tx: manual express
Detrusor atony
What is the issue occurring during Urge Incontinence aka detrusor instability/detrusor hyperreflexia?
-detrusor contraction during storage of urine or low compliance of the detrusor muscle, which may be confirmed by cystyometrography
What are the clinical signs of urge incontinence?
- pollakuria
- stranguria
- dysuria