Normal Micturition

Question 1

What nerves are involved in

1. Sympathetics
2. Parasympathetics
3. Somatic

Answer 1

1. T11-L2
2. S2-4
3. S2-4

Question 2

How does the sympathetic reflex in the bladder work (storage)

Answer 2

Stimulation of alpha adrenergic receptors at bladder neck increasing resistance
Activation of beta3 receptors in detrusor inhibiting contraction
Direct inhibition of detrusor motor neurons in sacral spinal cord

Question 3

Pontine micturition center

Answer 3

Receives afferent input from lower urinary tract
Receives input from forebrain, cerebellum and hypothalamus
Cortical inputs are inhibitory
Cerebellum involved in coordination of detrusor contraction and relaxation of bladder neck and external voluntary sphincter

Question 4

3 types of UMN lesions

Answer 4

Cerebral injury (stroke, tumour, brain injury) causing detrusor overactivity
Basal ganglia disease (PD) causing detrusor overactivity, slow relaxation of external sphincter
Suprasacral spinal cord damage causing detrusor overactivity with sphincter dyssynergia

Question 5

2 types of LMN lesions

Answer 5

Sacral spinal cord damage

Peripheral nerve damage

Question 6

DIAPERS for causes of transient/reversible incontinence

Answer 6

Delirium/ confusional state
Infection
Atrophic vaginitis/urethritis
Pharmacologic
Excess urine output
Restricted mobility
Stool impaction

Question 7

Investigations for urinary incontinence

Answer 7

Voiding diary
Urinalysis
Urine cytology with irritative symptoms
Postvoid residual by ultrasound
Renal ultrasound in specific cases

Question 8

Anticholinergic side effects

Answer 8

Dry mouth
Dry eyes
Blurred vision
Constipation
UGI distress
Headache, flushing
Confusion
(rarely) SVT