-
renal lymphatics:
draining capsule and parenchymal flow-->preaortic lymph nodes--> thoracic duct --> subclavian vein
-
Diaphragm motion is a major factor in lymph and venous return for GU. Diaphragm motion can be influenced by:
- SD of TL junction
- SD of lower ribs
- spasm of QL and psoas
- hyperlordosis
- SD of phrenic nerve
-
Symphathetic innervation of kidney:
- Kidney T10-L1
- superior mesenteric artery
-
sympathetic innervation of ureter:
- ureter T10-L1
- sup mes (upper urteter)
- inf mes (lower ureter)
-
sympathetic innervation of bladder:
- bladder T10-L1
- trigone
- detrusor
- transverse perineal m- Pudendal n. S2-4
-
sympathetic innervation of prostatic urethra:
L1-L2
-
sympathetic innervation of prostate:
L1-L2
-
sympathetic innervation of cervix:
L1-L2
-
sympathetic innervation of fallopian tubes:
T10-L2
-
sympathetic innervation of epididymis:
T11-L2
-
sympathetic innervation of ovaries and testes:
T9-T10
-
sympathetic innervation of uterus:
T10-L1
-
sympathetic innervation of adrenal:
T8-T10
-
Ureters:
- adhere to peritoneum and descend on psoas fascia
- psoas laterally displaces lower pole of each kidney
-
Bladder and Urethra:
- spinchter/trigone/ureteral orifices
- inhibited by parasympathetics
- bladder wall
- activated by parasympathetics
- inhibited by sympathetics
-
viscero-somatic reflex of kidney:
-
viscero-somatic reflex of ureter:
- T11-L3 ipsi
- sup mes (upper ureter)
- inf mes (lower ureter)
-
viscero-somatic reflex of bladder:
- T11-L3 bil
- trigone
- detrusor
- transverse perineal m-pudendal n. S2-4
-
viscero-somatic reflex of urethra:
T11-L2 bil
-
viscero-somatic reflex of fallopian tubes:
T10-L2 bil
-
viscero-somatic reflex of external genitalia:
T12 bil
-
viscero-somatic reflex of epididymis:
T11-L2
-
viscero-somatic reflex of ovaries and testes:
T10-T11 ipsi
-
viscero-somatic reflex of uterus:
T9-L2 bil
-
viscero-somatic reflex of adrenal:
T8-T10 ipsi
-
Chapman points of urethra:
- ant: superior aspect of superior pubic ramus
- post: tp of L3
-
chapman points of prostate:
- ant: lateral femur
- post: sacral sulcus
-
chapman points of bladder:
- ant: periumbilical
- post: tp of L2
-
chapman points of kidney:
ant: 1 inch lateral and 1 inch superior from umbilicus
-
chapman points of broad ligament:
- ant: lateral femur
- post: sacral sulcus
-
chapman points of uterus:
- ant: superior aspect of inferior pubic ramus
- post:
tp of L5 and sacral sulcus
-
chapman point of vagina:
post: sacral sulcus
-
chapman point of ovaries:
- ant: superior aspect of superior pubic ramus
- post: inf facet of T10
-
dysmennorhea:
- chapman's pts along IT band, pubic bone, or sacral ala
- (symp T10-L2, PS-S2-4)
- relieve edema, balance, autonomic tone
- pt may self-tx w/ knee to chest position to decompress pelvis and increase drainage
-
PMS:
- tx symptomatically
- headaches--cervical and subocciptial areas
- bloating and bowel frequency--tx segmentally related areas
- tx should begin before sx begin
-
endometriosis:
- sacral rocking to reduce parasymp
- tx dysfunction of T-L junction (T10-L2)
- mobilization of resp. diaphragm to improve circulation
- tx of pelvic diaphragm relieves congestion and lower extremity edema
- cranial, cervical, and sacral eval and tx to assist neuroendocrine system
-
pelvic floor dysfunction:
- SD of pelvis, sacrum &/or the pelvic diaphragm, as well as chapman's pts
- tx w/ bimanual relaxation of muscle contractions via inhibitory pressure, counterstrain, and myofascial techniques
- injections
- kegel excercises
-
vas deferens/seminal vesicles:
T12-L2 inf mes
-
prostate:
- secretory sympathetic fibers
- T12-L2
- stimulation of hypogastric plexus (which carries fibers from T12-L2) causes true glandular secretions
- pudendal nerve stimulation causes muscular contraction forcing secretions out of the urethra
-
kidneys parasymp innervation:
vagus
-
ureters parasymp:
- (maintain nml peristaltic waves)
- proximal vagus
- distal pelvic splanchnics S2-4
-
increased tone of symp to GU:
- increased tone
- Increased afferent arteriole constriction to kidney
- Ureterospasm and decreased peristalsis of ureters
- Relaxation of Bladder wall leading to reflux
- Increased tone to external urinary sphincter
- effects of increased tone
- Decreased GFR
- Decreased urinary output
- Increased blood pressure
- Uretero spasm-decreased urine flow through the ureters
- Incomplete emptying of bladder
- Encourages ureteral/prostatic reflux from bladder
- Complaints of premature or retrograde ejaculation
-
urologic parasympathetic pathophysiology:
- increased tone
- Increase peristalsis of ureters
- Increased bladder wall tone
- Relaxes external urinary sphincter
- decreased tone
- Incomplete bladder emptying
- Impotence
- TightensInternal Urinary Sphincter
-
pudendal nerve S2-4:
- External sphincter tone relies somewhat on innervation
- When increase intra abdominal pressure pelvic diaphragm and external sphincter contract
-
renal visceromotor:
increased tonus to thoracolumbar junction (lloyd's punch)
-
renal viscerosensory:
(ache)--flank or thoracolumbar area
-
ureteral visceromotor:
hypertonus to abdominal, erector spinae, cremasteric muscles
-
ureteral viscerosensory:
(uterocolic) lumbar region to illiac fossa over front of abdomen to scrotum
-
erection dependent on:
- pudendal n. S2-4
- parasymp S2-4
-
premature ejaculation:
- symp from L1-2
- somatic S2-4
-
micturition:
- Distension of bladder walls initiates spinal reflexes that:
- Stimulate contraction of the external urethral sphincter
- Inhibit the detrusor muscle and internal sphincter (temporarily)
- Voiding reflexes:
- Stimulate the detrusor muscle to contract
- Inhibit the internal and external sphincters
-
SD of pubic symphysis:
- Increased tension on urogenital diaphragm
- Increased tension on Puboprostatic or pubovesicular ligaments may lead to dysuria(nocturnal enuresis?)
- MFTrP-lower abdomen may cause-urinary frequency, urgency,sphincter spasm, residual urine, bladder pain Travel pp. 7671
-
iliolumbar ligament:
- old men
- pain can refer to ipsilateral groin, testicles, rectum, hip, low back
-
Chronic Pelvic Pain Syndrome (CPPS) prostadynia:
- Symptoms
- Irritative voiding symptoms and/or pain located in the groin, genitalia, or perineum in the absence of pyuria and bacteriuria
- Absence of pus cells or bacteria seen on microscopic analysis of the urine.
- Excess WBCs or bacteria seen on Gram stain and culture of expressed prostatic secretions (EPS) may be found.
- Most common urological diagnosis males > 50 years old
- Third most common diagnosis males < 50 years.
- Diagnosis results in + 2 million office visits per year. Average urologist sees approximately 10 patients with prostatitis per month
- Specific urinary pathogens are detected infrequently after culture.
- Majority of these patients are categorized as having chronic nonbacterial prostatitis or prostatodynia, otherwise known as CPPS
- etiology unknown:
-
morning sickness/hyperemesis:
-
round ligament pain:
L3-5 counterstrain points tx
-
risk factors for low back pain during pregnancy:
- heavy manual labor
- smoking
- parity
- age
-
symp labor & delivery:
- uterine muscle contraction
- vasoconstriction
- sensation from fundus to uterus
-
parasymp labor & delivery:
- uterine muscle relaxation
- vasodilation
- sensation from uterine cervix
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