Osteopathic Approach To GU Patient

Question 1

The sphincter, trigone, and urethral orifice of the bladder are activated by symapthetics at the levels of __ and inhibited by parasympathetics at the level of ___

Answer 1

T12-L2

S2-S3

Question 2

Which autonomic portion activates the bladder wall? What about inhibits?

Answer 2

Activated by Parasympathetics

Inhibited by sympathetics

Question 3

What is sympathetic innervation to the kidney and upper ureter and where do they synapse?

Answer 3

T10-L1, synapse in the superior mesenteric ganglion

Fibers for lower ureter synapse in inferior mesenteric ganglion

Question 4

What are sympathetics to the bladder and where do they synapse?

Answer 4

T12-L2, synapse at inferior mesenteric ganglion

Question 5

Activation of this parasympathetic nerve contracts the bladder and causes emptying

Answer 5

Pelvic splanchnic (S2-4)

Question 6

Activation of this sympathetic nerve relaxes the bladder and causes retention

Answer 6

Hypogastric plexus

Alpha adrnergic –> relaxes detrusor

Beta2 adrenergic –> closes internal urethral sphincter

Question 7

What is the somatic innervation that allows for voluntary contraction to close the external urethral sphincter?

Answer 7

Pudendal n. (S2-4)

Question 8

What is parasympathetic innervation to the kidney and proximal ureter?

Answer 8

Vagus n

Question 9

What is parasympathetics to distal ureter and bladder?

Answer 9

Pelvic splanchnic nerves (S2-4)

Question 10

What are some Ambulatory postural considerations for the renal pt for OS tx?

Answer 10

Diaphragm massages kidneys –> L1-L3 attachment

Psoas spasm can decrease lordosis, compress kidneys from flexed posture, restrict ureters

Lowers ribs, quadratus lumborum –> posterior wall of soma

Question 11

What are some techniques to stimulate sympathetics for urologic dysfunction?

Answer 11

Rib raising

T10-L2

Inf mesenteric ganglion

Question 12

What are some lymphatic techniques to tx urologic dysfunction?

Answer 12

Thoracic inlet and diaphragms

Rib raising

Lymphatic pump

Question 13

What are some ways to stimulate parasympathetics for urologic dysfunction?

Answer 13

OA/A

OM suture

Sacrum/pelvis

Question 14

Parasympathetics to kidneys should focus on the vagus n. and correct somatic dysfunction at the ___

Answer 14

OA

Question 15

Parasympathetic tx to the bladder should focus on the pelvic splanchnic n and correct the somatic dysfunction at ___

Answer 15

S2-S4

Question 16

Sympathetics to kidney and bladder should focus on correcting any somatic dysfunction at ___

Answer 16

T10-L2

Reduce stimulation to renal arteries –> reduce component of HTN

Reduce excessive relaxation of bladder –> complete emptying

Reduce ureterospasm of IUS –> urinary retention

Question 17

Common dysfunctions in BPH are found at ___

Answer 17

T11-T12

L1

Question 18

Common areas of dysfunction in nephrolithiasis are found at ___

Answer 18

T12-L2

S2-S4

May consider a Psoas spasm affecting hip motion if ureter involved

Question 19

Pyelonephritis has the same OS considerations as nephrolithiasis but Frymann associated ___ dysfunctions with renal dysfunction

Answer 19

Cervical

OA/AA connections with vagus

Question 20

The ureter travels across the ___ fascia and can cause contracture or spasm that may contribute to ureteral dyfunction

Answer 20

Psoas