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explain the mechanism of low pressure urine storage in the bladder
in order to maintain continence, pressure in the bladder must be lower than pressure in the urethra
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list three classes of autonomic drugs and their effect on bladder function
- cholinergic drugs stimulate PSNS that cause detrusor contraction
- B2 blockers block receptors that cause detrusor relaxation
- CCBs interfere with Ca to contract detrusor
- A1 agonist/blocker produce/block interal sphincter contraction
- Muscle relaxants - decrease external sphincter tone
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describe three urodynamic studies that can be used to assess bladder function
- uroflowmetry-flow rate during urination
- cystometry-bladder pressure during filling and voiding
- urethral pressure profile-intraluminal pressure changes in the urethra during rest
- sphincter electromyography-electric activity of voluntary muscle
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what does the parasympathetic nervous system do in the bladder?
promotes bladder emptying, produces contraction of the smooth muscle of the bladder wall and relaxation of the interal sphicter
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what does the sympathetic nervous system do in the bladder?
- promotes bladder filling
- produces relaxation of the smooth muscle of the bladder and contraction of the internal sphincter
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what does the somatic nervous system do in the bladder?
the striated muscles of the external sphincter and pelvic floor provide voluntary control of urination and maintenance of continence
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where does the immediate coordination of the normal micturition reflex occur?
in the micturition center in the pons, facilitated by descending input from the forebrain and ascending input from the reflex centers in the spinal cord
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causes of urinary tract obstruction?
- congenital obstruction
- prostate enlargement
- STDs and tumors
- stones
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compensatory changes in urinary tract obstruction?
- compensatory stage - hypertrophy of bladder,decreased ability to control spasm,
- decompensatory-frequency, hesitancy, need to strain, weak small stream, incomplete emptying
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differentiate lesions that produce storage dysfunction associated with spastic bladder from emptying dysfunction with flaccid bladder in terms of lesion level and effects
- spasm-lesion above the micturition reflex center in sacral cord,
- flaccid - injury to micturition center in sacral cord
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describe methods used in the treatment of neurogenic bladder
catheterization,bladder retraining, Rx manipulation of contractile
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differentiate stress,overactive/urge,and overflow incontinence
- stress - coughing, any increase in intra-abdominal pressure
- overactive/urge - urgency and frequency with hyperactivity of detrusor muscle
- overflow - involuntary loss when bladder pressure exceeds urethral pressure in the abscense of detrusor activity
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describe treatment of incontinence
- behavioral methods
- Rx
- exercises to strengthen muscles
- surgical correction
- noncatheter devices
- indwelling or self catheterization
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treatable causes of incontinence in elderly
- Delirium
- Infection
- Atrophic urethrits and vaginitis
- Pharmaceuticals
- Psychiatric disorders
- Excessive urine output
- Restricted mobility
- Stool impaction
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what are the signs of bladder cancer?
- freq/urgency
- dysuria
- hematuria
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what are the diagnostic measures for bladder cancer
- cytologic studies
- excretory urography
- cystoscopy
- biopsy
- ultrasound
- CT / MRI
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