The Lower Urinary Tract

Question 1

What structures are visible in the paramedian view of the female pelvis?

Answer 1

Levator ani (pelvic floor) and ureter are visible in the paramedian view of the female pelvis.

Question 2

What structures are present in the male pelvis?

Answer 2

The male pelvis contains the prostate, urethra, and vesicorectal pouch.

Question 3

What structures are visible in the paramedian view of the male pelvis?

Answer 3

The seminal vesicle, ejaculatory duct, and ductus (vas) deferens are visible in the paramedian view of the male pelvis.

Question 4

What are the components of the internal bladder anatomy?

Answer 4

The internal bladder anatomy includes the detrusor muscle, transitional cell epithelium with rugae, trigone, and ureteric orifice with diagonal insertion of the ureter through the bladder wall.

Question 5

What structures are present in the female pelvis?

Answer 5

The female pelvis contains the uterus, bladder, ureter, uterine artery and vein. There is a mnemonic “BRIDGE OVER WATER” to remember the structures.

Question 6

What type of epithelium lines the bladder wall and is impermeable to water and electrolytes?

Answer 6

The transitional cell epithelium lines the bladder wall and is impermeable to water and electrolytes.

Question 7

What are the types of smooth muscle bundles present in the bladder?

Answer 7

The bladder contains longitudinal and circular smooth muscle bundles.

Question 8

What filaments are aligned loosely in the bladder muscle and anchored to dense bodies?

Answer 8

Actin and myosin filaments are aligned loosely and anchored to dense bodies in the bladder muscle.

Question 9

How does contraction of the bladder muscle affect the cell?

Answer 9

Contraction of the bladder muscle shortens and thins the whole cell.

Question 10

What types of cholinergic receptors are present in the bladder muscle?

Answer 10

Muscarinic M2 and M3 cholinergic receptors are present in the bladder muscle.

Question 11

How are the bladder muscle cells connected?

Answer 11

The bladder muscle cells are connected by gap junctions, allowing for coordinated contraction.

Question 12

What is the location of the Pontine Micturition Centre (PMC)?

Answer 12

The Pontine Micturition Centre (PMC) is located in the pons region of the brain.

Question 13

What are the components of the sympathetic nerve supply to the bladder?

Answer 13

The sympathetic nerve supply includes the L2 nerve root, sympathetic ganglia, hypogastric plexus, and splanchnic nerves.

Question 14

What are the components of the parasympathetic nerve supply to the bladder?

Answer 14

The parasympathetic nerve supply includes the S2, S3, and S4 nerve roots and pelvic splanchnic nerves.

Question 15

What are the components of the somatic nerve supply to the bladder?

Answer 15

The somatic nerve supply includes the S2, S3, and S4 nerve roots and the pudendal nerve, which controls the urethral sphincter. Visceral afferents run with all of these nerves.

Question 16

What are the locations of the bladder receptors?

Answer 16

The bladder receptors can be stimulated by acetylcholine (ACh) and noradrenaline (NA).

Question 17

What are the types of muscarinic receptors found in the bladder?

Answer 17

The types of muscarinic receptors found in the bladder include M2 and M3 receptors.

Question 18

What is bladder compliance?

Answer 18

Bladder compliance refers to the ability of the bladder to expand and accommodate increasing volumes of urine without a significant increase in pressure.

Question 19

What adaptations are involved in the coordination of contraction and relaxation for emptying the bladder?

Answer 19

Adaptations involved in the coordination of contraction and relaxation for bladder emptying include the voluntary inhibition from higher centers and the presence of gap junctions that allow smooth muscle to contract as a whole.

Question 20

What is the characteristic of transitional epithelium in the bladder?

Answer 20

Transitional epithelium in the bladder is impervious to water and solutes, helping to prevent the leakage of urine into the surrounding tissues.

Question 21

What are the characteristics of a compliant bladder?

Answer 21

A compliant bladder is able to stretch and relax as it fills with urine, allowing it to accommodate increasing volumes without a significant increase in pressure.

Question 22

What happens to the smooth muscle in the bladder during filling?

Answer 22

The smooth muscle in the bladder relaxes during filling, allowing the bladder to accommodate the increasing volume of urine.

Question 23

What is the guarding reflex during the bladder filling phase?

Answer 23

The guarding reflex is initiated by stimulation of stretch receptors via the pelvic nerve and sympathetic stimulation via the hypogastric nerve. It leads to the contraction of the internal sphincter (alpha) and inhibition of the detrusor muscle (beta3). The external sphincter contracts via the pudendal nerve.

Question 24

What is the micturition reflex during the voiding phase?

Answer 24

The micturition reflex is triggered by intense stimulation of stretch receptors via the pelvic nerve. It involves the stimulation of the spinobulbospinal reflex and the Pontine Micturition Center (PMC). Parasympathetic stimulation via the pelvic nerve leads to detrusor muscle contraction (M3), relaxation of the internal sphincter, and relaxation of the external sphincter via the pudendal nerve.

Question 25

What is stress incontinence?

Answer 25

Stress incontinence is characterized by leakage of urine with increased abdominal pressure, such as during coughing, sneezing, jumping, or pelvic prolapse.

Question 26

What is overflow incontinence?

Answer 26

Overflow incontinence occurs due to chronic urinary retention, where the bladder becomes overly full and cannot empty properly, leading to continuous leakage.

Question 27

What is fistula incontinence?

Answer 27

Fistula incontinence is a type of incontinence caused by an abnormal connection (fistula) between the bladder and another organ, such as the vagina or rectum.

Question 28

What is urge incontinence?

Answer 28

Urge incontinence is associated with an overactive bladder and is characterized by the involuntary contraction of the bladder, leading to a strong urge to urinate and potential leakage.

Question 29

What are some drugs used for the treatment of urge incontinence?

Answer 29

Anticholinergics (such as oxybutynin and solifenacin), β3 agonist (mirabegron), and neurotoxin (botulinum toxin) are some drugs used to manage urge incontinence.

Question 30

How do anticholinergics work on the bladder?

Answer 30

Anticholinergics help relax the bladder muscles by blocking the action of acetylcholine, which reduces bladder contractions and helps control the urgency to urinate.

Question 31

What is the mechanism of β3 agonist on the bladder?

Answer 31

β3 agonists (e.g., mirabegron) stimulate β3 adrenergic receptors in the bladder, leading to relaxation of the detrusor muscle and increased bladder capacity.

Question 32

How does botulinum toxin affect the bladder?

Answer 32

Botulinum toxin injected into the bladder muscle blocks the release of neurotransmitters, reducing muscle contractions and improving bladder control.

Question 33

What are some treatment options for stress incontinence?

Answer 33

non-drug treatments for stress incontinence include weight loss, pelvic floor exercises, physiotherapy, and surgery. Drug treatment options include the use of a nicotinic agonist like duloxetine.

Question 34

What is the role of duloxetine in stress incontinence?

Answer 34

Duloxetine, a nicotinic agonist, can be used to treat stress incontinence by increasing the tone of the urethral sphincter and improving bladder control.

Question 35

What are non-drug treatment options for urinary retention?

Answer 35

Non-drug treatment options for urinary retention include weight loss, pelvic floor exercises, physiotherapy, and other techniques to improve bladder emptying.

Question 36

What are the common causes of urinary retention?

Answer 36

Urinary retention can be caused by conditions such as benign prostatic hyperplasia (BPH), ureteric obstruction, bladder diverticulum, or bladder stones.

Question 37

What is the flow test used for in urinary retention?

Answer 37

The flow test is a diagnostic test used to assess the rate and volume of urine flow. It helps differentiate between normal and obstructed urinary flow.

Question 38

What are the complications associated with urinary retention?

Answer 38

Complications of urinary retention can include dilatation of the renal collecting system (hydronephrosis) and enlargement of the prostate gland.

Question 39

What medications are commonly used to manage urinary retention in cases of benign prostatic hyperplasia (BPH)?

Answer 39

Alpha blockers like tamsulosin and 5 alpha-reductase inhibitors like finasteride and dutasteride are commonly used to manage urinary retention associated with BPH. Alpha blockers help relax the bladder neck, while 5 alpha-reductase inhibitors reduce the conversion of testosterone to dihydrotestosterone, which can reduce the growth factors contributing to BPH.

Question 40

What medications are commonly used to manage urinary retention in cases of benign prostatic hyperplasia (BPH)?