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27 Cards in this Set

  • Front
  • Back
Site of Activation of Micturition
M region of pons
-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.
Assess integrity of lower urinary tract and ID imp urethral/bladder lesions.
-Info about bladder compliance, capacity, and vol at 1st sensation & at urge to void.
-Gives voiding P
-Gives presence of uninhibited detrusor CTX
Neurophysiologic Studies in GU
EMG of sphincter and pelvic floor
Spastic Bladder and Urodynamic Studies
-Dec capacity and compliance
-Uninhibited detrusor CTX
Spastic Bladder
-UMN: lesion frontal lobes, pons, or suprasacral s.c.
-Sx: incontinence w/ urgency.
-Urodynamics: dec capacity & compliance.
Atonic Bladder
-LMN: at conus medullaris, cauda equina, sacral plexus, or periph n dysfunct.
-Overflow incontinence
-Urodynamics: inc capacity and compliance
Urge Incontinence
-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.
Detrusor Hyperreflexia
-Spastic bladder from neuro problem
-Common w/ stroke, suprasacral s.c. lesion, and MS
-Usually accompanied by detrusor-sphincter dyssynergia
Detrusor-Sphincter Dyssynergia
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.
Stress Incontinence
-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.
Mixed Incontinence
Urge + Stress Incontinence
Overflow Incontinence
-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.
Stroke and S.C. disease incontinence
~ UMN bladder or spasic bladder w/ or w/o sphincter dyssynergia
Small-fiber neuropathies and incontinence
Neurogenic atonic bladder w/ high PVR.
Incontinence w/ Supraspinal diseases (CVA, ,Parkinsons)
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.
Incontinence w/ Periph Nerve Diseases
-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
Incontinence w/ S.C. disease (injury or MS)
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
Tx Neurogenic Bladder
Behavior: toileting assistance, bladder retrain, pelvic musc rehab
Tx: Urge Incontinence/Spastic Bladder
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.
Tx: Stress Incontinence
1) Alpha-adrenergic agonists: phenylpropanolamine or pseudoephedrine
*stim sm musc alpha-adrenergic receptors
2) E therapy for postmenopausal w w/ stress/mixed
Tx: Atonic Bladder w/ Overflow Incontinence
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
Tx: Detrusor Dyssynergia
1) Intermittent cath
2) Suprapubic Cath
3) Sacral nerve stimulation
Erection NS
1) Parasymp S2-S4 (erection): release of local tissue mediators NO and cGMP to sustain erection.
Symp T11-T12 (ejaculation)
ED: patho
-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
ED: Tx
1) Selective inhibitors of cGMP phosphodiesterases: sildenafil and vardenafil
2) Intraurethral suppositories and intracavernosal injections of alprostadil