VOIDING

Question 1

Pudendal nerve during voiding

Answer 1

SYMPATHETIC so it is quiescent (external sphincter s2-4)

pelvic nerve is PARASYMPATHETIC so active (pelvic nerve s2-4)

Question 2

CP with incontinence

Answer 2

UDS usually shows overactive bladder with normal sphincteric activity; VCUG likely to show trabeculated bladder
can get external sphincter spasm after puberty

Question 3

voiding

Answer 3

inhibition of the striated external sphincter (pudendal nerve inhibition S2-4), inhibition of the sympathetic outflow (hypogastric nerve inhibition T10-L2), activation of the parasympathetic outflow to the bladder detrusor muscle (pelvic nerves S2-4), activation of parasympathetic outflow to the bladder neck and proximal urethra (pelvic nerves S2-4), followed by voiding. During normal voiding, there is inhibition of sympathetic outflow to the bladder base/bladder neck, and inhibition of pudendal outflow to the urethra (external urethral sphincter). In detrusor sphincter dyssynergia, there is failure of inhibition of the sympathetic outflow to the bladder/bladder neck and failure of inhibition of pudendal nerve outflow to the external sphincter, resulting in failure of relaxation of the internal and external sphincter complexes with detrusor contraction.

Question 4

botox..works…how?

Answer 4

inhibition of ACH release from post-synaptic EFFERENT nerves

Question 5

kids who fail desmopressin probably have..

Answer 5

reduced bladder capacity or DO