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Block 19 Module 3 > Urodynamic studies and Neuropathic bladder > Flashcards

Urodynamic studies and Neuropathic bladder Flashcards

1
Q

A muscle that forms the layer of the urinary bladder

A

Detrusor

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2
Q

The internal urethral sphincter is under involuntary control by

A

Sympathetic stimulation

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3
Q

External urethral sphincter is striated under voluntary control by the

A

Pudendal nerve

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4
Q

3 layers responsible for the contraction of the bladder wall

A

Outer longitudinal
Middle circular
Inner longitudinal

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5
Q

In the inner longitudinal layer the convergence of the muscle fibers froms a thickened bladder neck which functions as

A

Internal smooth-muscle sphincter

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6
Q

Main function of the bladder

A

Storage of urine

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7
Q

Normal capacity of bladder averages

A

350mL

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8
Q

Micturition reflex is located in

A

Sacral cord

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9
Q

When the sensation of fullness is transmitted to the sacral cord, what happens on the motor arc of the reflex

A

It causes a powerful and sustained detrusor contraction and urination if voluntary control is lacking

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10
Q

Normal residual urine volume in the bladder

A

0, but for clinical purposes <50 – normal

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11
Q

Only organ that is voluntary and at the same time under CNS control

A

Bladder

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12
Q

The door for the exit of the urine

A

Sphincteric unit

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13
Q

These 2 have to coordinate to affect the normal voiding pattern

A

Sphincter unit and the ureterovesical junction

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14
Q

2 sphincters involved in the sphincteric unit

A

Internal involuntary smooth muscle

External voluntary striated

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15
Q

Location of the internal involuntary sphincter

A

Near the bladder outlet

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16
Q

Location of the external sphincter

A

Proximal to the prostatic urethra

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17
Q

This unit prevents backflow

A

Ureterovesical unit

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18
Q

The ureterovesical unit is located at

A

Trigone

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19
Q

The superficial trigone is above the

A

Waldeyer’s sheath

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20
Q

This supplies the urinary bladder with autonomic nerves

A

Pelvic plexus

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21
Q

Parasympathetic innervation is derived from

A

S2-s4

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22
Q

Afferent innervation

A

Pudendal nerve

Hypogastric plexus

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23
Q

Parasympathetic efferent innervation

A

Pelvic plexus

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24
Q

You can control urination by trying to contract the

A

External sphincter

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25
Q

What happens in the fight or flight mechanism why there’s inhibition of urination

A

Sympathetic stimulation increases contraction of the internal urethral resistance of the sphincter

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26
Q

Micturition centers

A

Spinal cord (sacral) and Pons

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27
Q

Disorders of the bladder secondary to neuromuscular disease

A

Neuropathic bladder disease

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28
Q

This center elicits a direct reflex in infants

A

Sacral micturition center

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29
Q

Integration center for signals from bladder, cerebral cortex and hypothatlamus

A

Periaqueductal gray

30
Q

How does the pontine micturition center initiate voiding

A

Distention stimulates the PMC then it will send signals for the detrusor to contract and the sphincter to relax thus voiding

31
Q

End result of detrusor contraction

A

Sphincter relaxation

32
Q

Although micturition and urine storage are primary functions of the autonomic nervous system, these are under voluntary control from

A

Suprapontine cerebral centers

33
Q

pertains to disorders of the nerve conduction to the bladder

A

Neuropathic neuromuscular

34
Q

Lesions above sacral micturition center

A

Bladder spasticity
Dementia, CVA, MS, tumors
Spinal cord injury

35
Q

Lesions below sacral micturition center

A

Flaccid

Injury at the center, s2-s4

36
Q

Involuntary contractions with coordinated sphincter function indicates a lesion where

A

Above the brainstem

37
Q

What will happen initially if there’s a lesion above the brainstem

A

Detrusor areflexia

38
Q

Ddx if lesion is above the brainstem

A 
Cystitis
Chronic urethritis
Interstitial cystitis
Cystocele
Bladder outlet obstruction
39
Q

Sphincter is not coordinating with the bladder

A

Dyssynergia

40
Q

T or F: Normally if the bladder contracts the sphincter should also contract

A

False: if the bladder contracts the sphincter should relax

41
Q

If there’s involuntary bladder contractions without sensation the lesion is where

A

Complete spinal cord lesions from level T6-S2

42
Q

If there’s bladder spasticity/contracted bladder where’s the lesion

A

Above the sacral micturition center (S2-S4)

43
Q

Loss of inhibition from higher centers resuls in

A

Overactive bladder and sphincter bhvr on the segmental lvl

44
Q

Spastic neuropathic bladder is typified by

A 
Reduced capacity
Involuntary detrusor contractions
High intravescial voiding pressures
Marked hypertrophy of the bladder wall
Spasticity of the pelvic striated muscle
Autonomic dysreflexia in cervical cord lesions
45
Q

If there’s frequency in urination the lesions is located in

A

Spinal cord

46
Q

Manifestation if there’s complete spinal cord lesion

A

Sensation of bladder fullness becomes absent

47
Q

What happens initially if there’s spinal shock

A

Urinary retention

48
Q

One of the first indications of return of detrusor reflex activity

A

Strong detrusor contraction in response to filling with cold saline

49
Q

Test used to differentiate upper from lower motor neuron lesions early in the recovery phase

A

Ice water test

50
Q

If the injury is at the upper motor what would be the manifestations

A

Spastic – spontaneous spasms in the extremeties, leakage of urine or stool

51
Q

If the injury is at the lower motor what would be the manifestations

A

Flaccid

52
Q

Flaccid neuropathic bladder is aka

A

Neurogenic areflexic bladder

53
Q

Direct injury to the peripheral innervations of bladder or sacral segments S2–4 results in

A

Flaccid paralysis of the bladder

54
Q

Principal urinary symptom of flaccid neuropathic bladder

A

Retention with overflow incontinence

55
Q

s/sx of neurogenic overactive bladder

A

Lack of true sensation of fullness and involuntary urination

56
Q

Used to assess the integrity of the urethra and identify stricture sites

A

Cystourethroscopy, ureteroscopy

57
Q

Abnormal bladder capacity caused by flow into the blind sacs or diverticula

A

Cystocoele

58
Q

This is done if there’s urethral sphincter dyssynergia

A

Sphincterectomy

59
Q

Treatmen of spastic neuropathic bladder includes

A 
Foley catheterization
Sphincterectomy
Sacral rhizotomy
Neurostimulation
Urinary diversion
60
Q

implanting a bladder pacemaker to stimulate sacral nerve roots and accomplish bladder evacuation

A

Neurostimulation

61
Q

Treatment for spinal shock

A

Foley catheterization
Suprapubic cystostomy
Control of infection and calcium stone prevention

62
Q

How is crede maneuver done

A

Manually pushing on the suprapubic area

63
Q

This is indicated for hypertrophy of the bladder neck or an enlarged prostate

A

Transurethral resection of the bladder neck

64
Q

Effect of parasympathomimetic drugs

A

They provide increased bladder tonus to help contract effectively

65
Q

Complications of neuropathic bladder

A

Recurrent UTI
Hydronephrosis (d/t ureteral reflux or obstruction)
Stone formation

66
Q

Techniques used to obtain graphic recording of activity in the urinary bladder, urethral sphincter and pelvic musculature

A

Urodynamic studies

67
Q

Urodynamic studies are used to evaluate

A

Bladder and sphincter function and act of voiding

68
Q

Study of flow of urine from urethra

A

Uroflowimetry

69
Q

Used to measure reservoir function of lower urinary tract

A

Cystometry

70
Q

Used to monitor urethral activity

A

EMG

Block 19 Module 3 (9 decks)

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