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27 Cards in this Set
- Front
- Back
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Site of Activation of Micturition
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M region of pons
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PVR
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-Normal is <50mL
-Inc assoc w/ poor bladder emptying. -Sphincter dyssynergy & atonic bladder most common neurogenic causes of inc PVR. -Small PVR good. Lg PVR w/ spastic or atonic bladder is not. It can cause inc intrabladder P w/ deleterious effect on ureters & kidneys. |
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Cystourethroscopy
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Assess integrity of lower urinary tract and ID imp urethral/bladder lesions.
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Cystometry
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-Info about bladder compliance, capacity, and vol at 1st sensation & at urge to void.
-Gives voiding P -Gives presence of uninhibited detrusor CTX |
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Neurophysiologic Studies in GU
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EMG of sphincter and pelvic floor
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Spastic Bladder and Urodynamic Studies
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-Dec capacity and compliance
-Uninhibited detrusor CTX |
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Spastic Bladder
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-UMN: lesion frontal lobes, pons, or suprasacral s.c.
-Sx: incontinence w/ urgency. -Urodynamics: dec capacity & compliance. |
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Atonic Bladder
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-LMN: at conus medullaris, cauda equina, sacral plexus, or periph n dysfunct.
-Overflow incontinence -Urodynamics: inc capacity and compliance |
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Urge Incontinence
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-Invol loss urine assoc w/ urgency, usually assoc w/ detrusor instability.
-Detrusor hyperreflexia=if neuro prob w/ sx spastic bladder. DH common in stroke, suprasacral s.c. lesion, and MS and ~ accompanied by detrusor-sphincter dyssynergia- can result in urine retention, reflux, and renal damage. |
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Detrusor Hyperreflexia
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-Spastic bladder from neuro problem
-Common w/ stroke, suprasacral s.c. lesion, and MS -Usually accompanied by detrusor-sphincter dyssynergia |
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Detrusor-Sphincter Dyssynergia
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Inappropriate CTX ext sphincter w/ detrusor CTX
-Results in urine retention, vesicouretheteral reflux, adn subsequent renal damage. -Assoc w/ urge incontinence and deterusor instability. -Sphincter dyssynergia produces inc PVR w/ fluctuating voiding pressures and varying flow rate. |
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Stress Incontinence
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-Invol loss urine w/ cough/sneeze/laugh/phys activity that inc intra-abd P (in absence of detrusor CTX or overdistended bladder)
-RF: multiparous w. w/ cystocele or weak pelvic floor muscles. Urethral hypermobility. Sig displacement of urethra & bladder neck. Intrinsic urethral sphincter defic due to congen weakness in pts w/ myelomeningocele or epispadias or have had prostatectomy, trauma, or radiation. |
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Mixed Incontinence
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Urge + Stress Incontinence
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Overflow Incontinence
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-LMN: Invol loss urine assoc w/ overdistention of bladder
-Constant dribble/urge/stress incont sx -Resultant atonic bladder can be prod by underactive/acontractile detrusor from drugs/diabetic neuropathy, lower s.c. injury, or radical pelvic surgery that interrupts innerv to detrusor. -Bladder outlet and urethral obstruction can also cause overdistention and overflow. |
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Stroke and S.C. disease incontinence
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~ UMN bladder or spasic bladder w/ or w/o sphincter dyssynergia
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Small-fiber neuropathies and incontinence
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Neurogenic atonic bladder w/ high PVR.
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Incontinence w/ Supraspinal diseases (CVA, ,Parkinsons)
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Hyperreflexic bladder, causes urge incontinence, reduced bladder capacity, small PVR w/o deleterious effects on upper urinary tract b/c voiding unobstructed.
1) Lg stroke esp frontal/pontine prod UMN bladder (hyperreflexic w/ urgency and freq)and poor funct outcome 2) PArkinson's: voiding dysfunct 40-70% w/ DH #1. Pseudodyssynergia consequence of sphincter bradykinesia and BPH is freq assoc. |
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Incontinence w/ Periph Nerve Diseases
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-aka polyneuropathy of small autonomic nerve fibers
-Urodynamics: impaired detrusor CTX, dec bladder sensation, dec Q, and inc PVR -Exp: diabetic cystopathy w/ progressive loss of bladder sensation and impairment of bladder emptying eventually results in chronic low-P urinary retention -Also see w/ GBS, amyloid, injury to pelvic n by local radiation/surg |
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Incontinence w/ S.C. disease (injury or MS)
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Hyperreflexic bladder, causes urge incontinence, reduced bladder capacity, small PVR w/o deleterious effects on upper urinary tract b/c voiding unobstructed.
1) Spinal shock: bladder acontractile but gradually over wks, relex detrusor CTX dev in response to low filling volumes 2) S.C. injury: DH, loss of compliance, and DSD 3) MS: Irritative sx, obstructive sx, mixed sx. 50% w/ DSD |
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Tx Neurogenic Bladder
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Behavior: toileting assistance, bladder retrain, pelvic musc rehab
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Tx: Urge Incontinence/Spastic Bladder
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1) Antichol agents: tolterodine>oxybutynin, propantheline
2) TCA (imipramine) 3) DDAVP (desmopressin)- used for D.I. 4) Intravesical Capsaicin: for intractable detrusor hyperreflexia to dec urgency and freq. |
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Tx: Stress Incontinence
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1) Alpha-adrenergic agonists: phenylpropanolamine or pseudoephedrine
*stim sm musc alpha-adrenergic receptors 2) E therapy for postmenopausal w w/ stress/mixed |
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Tx: Atonic Bladder w/ Overflow Incontinence
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1) Crede's/Valsalva to empty bladder
2) Self Cath LT tx 3) Pharmaco ~not effective 4) Bethanechol stim chol receptors to inc detrusor tones--SE's bronchospasm, diarrh, abd pain, flush |
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Tx: Detrusor Dyssynergia
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1) Intermittent cath
2) Suprapubic Cath 3) Sacral nerve stimulation |
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Erection NS
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1) Parasymp S2-S4 (erection): release of local tissue mediators NO and cGMP to sustain erection.
Symp T11-T12 (ejaculation) |
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ED: patho
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-Often multifactorial. Neuro causes stroke, MS, diabetes
-Meds: antiHTN, antichol, antidepressant, sedative, narc -Labs: PL, T, gonadotropins, Sleep study (erection w/ REM), EMG and somatosensory evoked potentials to help in cases of myelopathy or periph n. disease. Vasc studies eval response to injection of vasoactive agent papaverine |
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ED: Tx
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1) Selective inhibitors of cGMP phosphodiesterases: sildenafil and vardenafil
2) Intraurethral suppositories and intracavernosal injections of alprostadil |
