Neuro-urology

Question 1

Why do parkinsons patient have OAB?

Answer 1

decreased dopamine, dopamine promotes detrusor relaxation

Question 2

Name 3 malfunctions in neuro pathways that can lead to OAB

Answer 2

1. M3 cholinergic receptors
   -neuro plasticity changes A-delta fibers to C- fibers
   -C fibers convey increased pain and stretch.
2. B3 adrenergic receptor signals
   -alternation leads to unchecked activation and inability to block parasympathetic signals which cause detrusor contraction
3. Abberant signals from S2-S4, peripheral nerve damage

Question 3

MS patient presents. Wants to know her risk of having:

OAB
detrusor sphincter dysynergia
retetion:

Answer 3

OAB: 50%
detrusor sphincter dysynergia: 25%
retetion: 25%

Question 4

Discuss the process of autonomic dysreflexia?

Answer 4

Sympathetic surge which increases BP in the thoracolumbar vessels–>

the brain tries to counteract, but due to spinal cord injury, it can’t—>

so then brain lowers heartrate and decreases perfusion to heart and brain

above T6

Question 5

Neuro physiology of the sigmoid and rectum

sympathetic input comes from what nerve?

What muscle does this control?

Answer 5

inferior and superior hypogastric chain

controls tone/relaxation of bowel smooth muscle

Question 6

Neuro physiology of the sigmoid and rectum

parasympathetic input comes from what nerve?

What muscle does this control?

Answer 6

s2-s4 splanic nerves

activation causes rectal peristalsis/skeletal muscle change

Question 7

What is the RAIR?

Answer 7

recto-anal inhibitory reflex

-autonomic control
triggered by distention of the rectum
-transient relaxation of internal anal sphincter coupled with contraction of the external anal sphincter
-allows you to pass air without solid or liquid

Question 8

what nerves are particularly impacted by uncontrolled diabetes?

Answer 8

sacral nerve roots, pelvic nerve