Voiding Dysfunction

Question 1

role of nervous system in micturition:

parasympathetic: facilitates _____
sympathetic: facilitates _____

Answer 1

micturition; urine storage

Question 2

how does the sympathetic nervous system facilitate urine storage?

Answer 2

inhibition of detrusor (beta2 adrenergic receptors), contraction of “internal sphincter” (alpha adrenergic receptors)

Question 3

what divisions of the nervous system are responsible for voluntary control over micturition?

Answer 3

CNS and the somatic division of PNS

Question 4

what division of the nervous system is responsible for motor activation of detrusor contraction?

Answer 4

parasympathetic division of autonomous PNS

Question 5

role of pontine micturition center

Answer 5

coordination of detrusor and sphincters

Question 6

describe the micturition reflex

Answer 6

autonomic reflex; bladder fills with urine causing stretching of bladder wall –> send signals to spinal cord that promote detrusor contraction

Question 7

how is micturition reflex modulated?

Answer 7

CNS (cortex) sends inhibitory signals to “turn off” micturition reflex; when decision to urinate is made, CNS removes inhibitory signals and external sphincter relaxes

Question 8

detrusor contraction: ______ innervation

internal sphincter relaxation: ______ innervation

Answer 8

parasympathetic; sympathetic

Question 9

urge incontinence: what is it and how is it treated?

Answer 9

uncontrolled urine leakage that occurs immediately after an urgent, irrepressible need to void (micturition reflex is not being inhibited by the brain); treated with pelvic floor exercises, anticholinergic medications (inhibit overactive detrusor contractions) and beta-3 agonist (relaxes detrusor)

Question 10

stress incontinence: what is it and how is it treated?

Answer 10

urine leakage caused by abrupt increases in intra-abdominal pressure (e.g., with coughing, sneezing, laughing, bending, or lifting) due to weakness of the urethral and bladder neck support structures or weakness of the urethral/periurethral/bladder neck musculature (caused by childbirth, surgery, pelvic trauma); treated with pelvic floor exercises, duloxetine, surgery to lift/support urethra and bladder neck

Question 11

overflow incontinence: what is it and how is it treated?

Answer 11

dribbling of urine from an overly full bladder (chronic urinary retention), mostly due to BPH in men; treated with catheter drainage of bladder and trying to reverse any outlet obstruction present

Question 12

functional incontinence: what is it

Answer 12

urine loss due to cognitive or physical impairments or environmental barriers

Question 13

stress incontinence: risk factors

Answer 13

vaginal/pelvic trauma, lack of estrogen (menopause), neurologic (spina bifida), radiation therapy, obesity

Question 14

urge incontinence: risk factors

Answer 14

lack of estrogen (menopause), obesity, pelvic organ prolapse, pelvic floor dysfunction

Question 15

_______ inhibits the detrusor and activates the bladder neck/internal sphincter for urine storage

Answer 15

sympathetic nervous system

Question 16

______ controls the external sphincter (voluntary control)

Answer 16

somatic nervous system

Question 17

give short descriptions of urge, overflow, and stress incontinence

Answer 17

urge: due to hyperactive/overactive bladder
overflow: due to weak overdistended bladder
stress: due to weak/damaged sphincter

Question 18

what types of medications can cause urinary retention?

Answer 18

anticholinergics, alpha-agonists, and narcotics

Question 19

lesion in brain (tumor, stroke) –> what kind of urinary problems?

Answer 19

lack of inhibition of micturition reflex by the brain

Question 20

lesion in spinal cord between pons and sacral spinal cord –> what kind of urinary problems?

Answer 20

hyperactive bladder, destrusor-sphincter dyssynergia