NGB

Question 1

autoaugment

Answer 1

ok for regular sized bladder but with poor compliance

never reported to pop

Question 2

small high pressured NGB with bilateral HG vur

Answer 2

augment with ureteroureterostomy plus reimplantation (can’t reimplant both b/c bladder is too small)

Question 3

how does botox work

Answer 3

inhibition of ach from POSTsynaptic nerves (parasymp efferent)
also think botox for OAB and not to increase compliance

Question 4

mirabegron

Answer 4

b3 receptor stimulation causing smooth m relaxation via sympathetic nerves

Question 5

will you have DSD with NGB??

Answer 5

if you have sacral reflex arc then YES MAYBE!! test with bulbocavernosal reflux
unlike SCI can’t rely on level of lesion for myeodysplasia

Question 6

electrolytes and augments…

Answer 6

augments will absorb chloride and thus also hydrogen ions (ACIDOSIS)
check bicarb before augment (if low they are already acidotic)

Question 7

Autonomic Dysreflexia

Answer 7

complete Lesions above T8; cannot stop SYMPATHETIC outflow
must have intact distal SC (so their body can feel afferent fibers from bladder with filling)
hypertension / bradycardia / flushing
tx: cath bladder / check rectum / 1’ nitropaste
if pt on PDE 5 inhibitors then oral captopril (otherwise will get rebound hypotension)

can pre-tx with captopril or alpha blockers prior
to procedure