Voiding Dysfunction Flashcards
what parasymp receptor mediates bladder control?
M3/M2
what does sympathetic activation do at bladder?
allows for filling via relaxation of the SM
what is the sympathetic receptor in the bladder?
B3
what is the sympathetic in charge of with the bladder outlet and internal urethra?
contraction
what sympathetic receptor is in charge of the bladder outlet contraction and urethral contraction?
alpha receptors
what does the somatic nervous system control with the bladder?
external sphincter
what is the cerebral micturition center in charge of?
telling bladder not to activate…really controls when you go
what is the pontine micturition center in charge of?
helps with coordination of activities with the sphincters and bladder
what is the sacral micturition center in charge of?
processes afferent signals and routes efferent signals
what does bladder overactivity mean?
bladder contracts when we dont want it to
what are symptoms of bladder overactivity?
urinary urgency and frequency with urge incontinence
what is issue in decreased storage volume of bladder?
decreased capacity to fill..you get afferent receptors activating earlier at lower volumes
what are symptoms of decreased storage volume?
urgency and frequency
what is issue with a stiff bladder?
you have low compliance of the bladder
what is the cause of stress incontinence?
weak or damaged sphincter muscles that lapse when cough or sneezing
what are two ways to limit bladder emptying?
decreased bladder contractility and increased outlet resistance
what are four ways to have decreased bladder contraction?
overdistension infection fibrosis and drugs or parasympathetic neural issue
what can be overactive that causes bladder outelt obstruction?
external sphncter
name some urine outlet obstruction causes
prostatic obstruction scar...stricture mass iatrogenic pelvic organ prolapse
what two prostate issues can cause outlet obstruction
BPH and cancer
how do you measure urine flow?
uroflowmetry
if there is a slow flow rate, what two things to think about?
outlet obstruction or detrussor dysfxn
what are four things you can do for an overactive bladder with decreased storage?
behavioral modifications
improve constipation
weight loss
pelvic muscle exercises
if you have an over active bladder, what can you give for it?
anticholinergics or beta agonists
what are the anticholinergics for overactive bladdeR?
oxybutynin and tolterodine
what are the B3 agonists for overactive bladder?
mirabegron
what can you do to fix weak or damaged outlet muscles?
NOTHING
what can be done to help with bladder emptying issues?
nothing really…intermittent cath
if you have outlet overactivity or detrusor xternal sphincter dysynergi, what is best rx option?
bypass with cath
if you have BPH and bladder outlet obstruction, what meds can you give?
alpha blockers relax smooth muscle withing bladder nneck and prostate
what med is alpha blocker to help with BPH?
tamsulosin
what can you give to shrink prostate in BPH?
finasteride..5a reductase inhibitors
how do you image for bladder trauma?
CT cystogram
what is a CT cystogram?
retrograde bladder fill with cath with water soluble contrast
how do you manage extraperitoneal bladder trauma?
foley cath drainage
how do you manage an itraperitoneal injury to bladder?
surgical interventions
how do you evaluate for suspicion of urethral trauma?
retrogrde urethrogram
what is a retrograde urethrogram?
catheter tipped syringe in meatus and empties cntrast
what is a cystourethroscopy?
direct visualization of the urethra
who gets a retrograde urethrogrm?
males
who gets a cystourethroscopy?
females
what is worrisome for urethral trauma?
blood at urethral meatus after pelvic trauma
