Voiding Flashcards
smooth muscle sphincter contraction and relaxation is controlled by?
alpha-adrenergic fibers of the SNS
detrusor muscle contraction and relaxation is controlled by?
cholinergic fibers of the PNS
striated muscle sphincter contraction and relaxation is controlled by?
somatic nervous system
what are the two main phases of voiding?
filling/storate and emptying
beta adrenergic fibers of the SNS are (stimulated/inhibited) during the filling phase to (contract/relax) the bladder
stimulated; relax
cholingeric fibers of the PNS (stimulate/inhibit) (contraction/relaxation) of the bladder during the filling phase
inhibit contraction
the pudendal nerve is (stimulated/inhibited) during the filling phase to (contract/relax) the external sphincter
stimulated; contract
during the emptying phase, the pudendal nerve is (stimulated/inhibited), leading to (contraction/relaxation) of the external sphincter
inhibited; relaxation
during the emptying phase, the (SNS/PNS) is stimulated to (contract/relax) the detrusor muscle
PNS; contract
what type of receptor is stimulated during detrusor contraction?
M3 muscarinic receptors
stimulation of the PNS (what spinal cord level?) results in bladder _____ and (storage/emptying)
S2-S4; contraction; emptying
stimulation of the SNS at spinal cord level ____ results in bladder _____ via __ fibers, and bladder outlet/urethral ____ via __ fibers
T11-L2; relaxation (beta); contraction (alpha)
stimulation of the pudendal nerve at spinal cord level _____ results in urine (storage/emptying)
S2-S4; storage (keeps it in)
the cerebral cortex is responsible for (stimulating/inhibiting) the sacral micturition center
inhibiting (tells you not to go)
the pontine micturition center coordinates (contraction/relaxation) of the urinary sphincter
relaxation (when the bladder contracts)
efferent arm of sacral micturition center (S2-S3) results in (parasympathetic/sympathetic) signals that cause bladder (contraction/relaxation)
parasympathetic; contraction
three bladder causes of filling/storage problems
poor compliance (fibrosis, nerve injury); decreased capacity (small bladder); overactivity (aging, neurologic)
outlet cause of filling/storage problems
weak or damaged sphincter muscle does not stay closed, leading to incontinence (pregnancy, prostatectomy)
bladder cause of emptying problems
decreased or absent bladder contraction (neurogenic, decreased sm muscle activity - overdistension from diabetes)
outlet causes of emptying problems
overactive outlet (pelvic floor dysfunction) or obstruction (prostatic, stricture, mass, sling, organ prolapse)
signs of filling/storage problem
urinary urgency, frequency, or incontinence
signs of emptying problem
hesitancy, straining, weak stream, intermittent stream, incomplete emptying, urinary retention, overflow incontinence
two other symptoms that you should consider when evaluating the urinary system
GI, neuro
common medication that can cause urinary retention
sudafed
uroflow measures?
flow rate and volume (emptying phase)
if a patient has decreased flow, think? (2 things)
outlet resistance/obstruction or poor detrusor function
if post-void residual is elevated, think? (2 things)
poor detrusor function or increased outlet resistance/obstruction
urodynamics measures ____ phase(s), is (cheap/expensive), and invasive
both phases (storage and emptying)
which voiding problem cannot be treated?
poor detrusor contraction
treatment of storage problems related to bladder compliance, capacity, or overactivity
anticholinergics to help relax bladder (side effects = dry)
botox can be used to tx?
bladder overactivity
when storage problems are related to outlet incompetence, tx includes?
physical therapy, weight loss, sling, collagen injection to manually obstruct urethra
tx of bladder-related emptying problems
no meds to improve detrusor contraction; options include catheterization and urinary diversion
tx of outlet-related emptying problems: external sphincter dysynergia
bypass it with intermittent cath; botox to deaden sphincter
tx of outlet-related emptying problems: pelvic floor dysfunction
PT to learn to relax muscles; electrical stimulation; stress reduction
tx of outlet-related emptying problems: prostatic obstruction
prostatectomy if cancer; alpha blockers to relax prostate (tamsulosin, alfuzosin); 5-alpha reductase inhibitors to shrink prostate (finasteride, dutasteride); surgery to trim prostate (TURP)
