voiding dysfunction

Question 1

Bladder has simplistic function with complex nervous system regulation

Answer 1

Urine storage: facilitated by sympathetic nervous system
Urine emptying/voiding: facilitated by parasympathetic nervous system
CNS provides oversight/regulation

Question 2

Micturition reflex

Answer 2

Autonomic reflex between bladder and spinal cord promoting bladder emptying,
Bladder fills with urine causing stretching of bladder wall (stretch receptors acitvated and send signals back to spinal cord that promote detrusor contraction)

Descending signals from CNS inhibit detrusor (at rest), sphincters contracted–> Urine Storage–> Release of central inhibition of detrusor (brain descides its time to pee), external sphincter relaxes, detrusor contracts, Bladder neck/internal sphincter relaxes–> urine emptying

Question 3

Micturition is modulated by CNS

Answer 3

CNS (cortex) sends inhibitory signals to turn off micturition reflex in cognitively intact people (otherwise wed pee all the time like a baby)

Micturition reflex can also be abolished by external sphincter contraction (gaurding reflex, voluntary/involuntary contraction of sphicter)

When decision to urinate is made, CNS removes the inhibitory signals and external sphincter relaxes to allow for micturition reflex to occur

Question 4

Pontine mucturition center coordinates voiding

Answer 4

PMC coordiates Detrusor contraction (parasympathetic control), internal sphincter relaxation (sympathetic control), external sphincter relaxation (Somatic control, voluntary)

Damage to the brainstem/pons or spinal cord lesions below the brainstem –> discoordination of these phenomena (Detrusor contracts simulataneously with external sphincter, excessively high bladder pressures and trouble emptying bladder)

Parasympathetic system –> urine voiding
Sympathetic–> urine storage

Question 5

Voiding dysfunction

Answer 5

Failure to store urine: Bladder (detrusor) dysfunction (overactive OAB vs underactive, urge incontinence), Under active or weak detrusor Chronic urinary retention and bladder overdistension (overflow, incontinence). Urethral sphincter dysfunction or weakness sTress incontinence

Failure to empty urine- Bladder (detrusor) dysfunction: weak/underactive/atonic/areflexic, Urethral obstruction (anatomic- Prostatic enlargement, urethral stricture, prior incontinence surgery)
Functional- hyper actice sphincter, neurogenic- detrusor sphincter dyssynergia, non-neurogenic- dysfunctional voiding

Question 6

host defenses

Answer 6

Physical force of urine flow, frequent/complete bladder emptying, anatomy (favors male) vagina, urethral length–> UTIs more common in women, exfoliation of urinary tract cells with attached bacteria, antimicrobial proteins, overall immune function

Question 7

Pathogen factors

Answer 7

Pili- hooks that adhere with ecoli

Question 8

UTI types

Answer 8

Lower tract UTI (bladder, prostate, urethra)- mainly bladder (cystits)

Upper tract UTI (Kidney, ureter)- mainly kidney pyelonephritis

Question 9

UTI epidemiology

Answer 9

Female&raquo_space; male, many women will develop a UTI in their lifetime, many are nosocomial (hospital acquired) infections are UTIs, many are gram (-) start in the hospital –> bacteremia

Question 10

Cystitis symptoms

Answer 10

Dysuria- Painful urination (burning, stabbing, peeing shards of glass)
Urinary frequency- needing to urinate often (it hurts to hold urine)
Suprapubic pain/discomfort/pressure
Cloudy smelly urine
Hematuria- blood in urine (gross (visible), microscopic

kidney infection- systemic symptoms

Question 11

Complicated vs Uncomplicated UTIs

Answer 11

Uncomplicated UTI- healthy patient with normal urinary tract (young, run of the mill, triggered by sex)

Complicated UTI- associated with factors that predispose to bacterial infection and decrease efficacy of therapy (more prone to become disseminated– sepsis and even death)

Question 12

complicated UTI

Answer 12

Abnormal GU tract (anatomic or functional)- urinary obstruction (BPH, scar tissue, stone), urinary stasis (incomplete bladder emptying, diverticulum), Vesicouretereal reflux (backwashing of urine from bladder to ureters/kidney- mainly a pediatric issue), Foreign body (catheter, stone), neurogenic bladder with high pressures (spinal cord injury)

Immunocompromised/unhealthy pt- diabetes, transplant patients, chronic steroids

Multi drug resistant bacteria

Question 13

Ua dipstick

Answer 13

lymphocyte esterase (are there PMNs in the urine)
Nitrites (are there bacteria in the urine)
Peroxidase (Blood, RBCs)

Question 14

Uropathogens

Answer 14

E coli, S aureus, klebsiella

Long term - Bactrim,
MEthanamine, Cranberries
Estrogen increased–> acidic vagina
Only treat asymptomatic abx for pregnancy