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17 Cards in this Set
- Front
- Back
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What are the UDS findings in complete spinal cord transection at T10 after spinal shock has disappeared?
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detrusor hyperreflexia, striated sphincter dyssynergia, and smooth sphincter synergia
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UDS for Shy-Drager syndrome?
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open BN at rest, dec detrusor compliance, striated sphincter denervation
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Autonomic hyperreflexia
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detrusor hyperreflexia, striated and smooth sphincter dyssynergia
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when do you see smooth sphincter dyssynergia?
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lesions above T6
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Which condition is assoc with detrusor striated sphincter dyssynergia?
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suprasacral spinal cord injury
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Summarize the parasympathetic innervation of the bladder
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parasympathetic efferents from pelvic nerves S2-S4. The ganglion is located near the organ and the neurotransmitter is acetylcholine. Receptors are M2/M3 and stimulation results in bladder contraction
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What is the role of sympathetic innervation of the bladder and outlet?
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Together promote bladder storage via the hypogastric nerve (T10-L2). Alpha (bladder base and prostate) and beta (bladder body) receptors exist on the bladder and alpha-R are on the prostatic capsule. Beta activation results in inhibition of muscle contraction. Alpha results in increased outlet resistance.
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What is the most common type of muscarinic R in the bladder?
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M2 80%. Exact fcn unknown but thought to be involved with neuromodulation of bladder compliance.
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Which muscarinic R is most involved with cholinergic stimulation of the detrusor?
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M3 20%
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What is the most common cause of upper tract deterioration in the SCI patient?
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striated sphincter dyssynergia leads to elevated detrusor P, high residual urine, hydro with secondary infections, and renal failure
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What is the clinical presentation of tethered cord syndrome?
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present in infancy with detrusor areflexia and urinary retention
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What are the characteristics of diabetic cystopathy?
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inc bladder capacity, impaired detrusor contractility, and dec bladder sensation, with diminished urinary stream
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Initial management of newborn with MMC?
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serum electrolytes, BUN, Cr, residual urine, RUS, and VCUG. UDS the day prior to closure not indicated.
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When should UDS be performed for MMC?
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In newborn period as baseline study to assess relative risk to upper tracts and to monitor any changes during the course of the disease.
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What is the main indication for pressure-flow studies?
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to help distinguish detrusor hypocontractility from urethral obstruction low-flow conditions, with or w/o large residual volume
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Does a suspension procedure help with ISD?
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No. A pubovaginal sling procedure is indicated.
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Why is nocturnal enuresis common with orthotopic diversion?
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loss of spinal reflex arc recruiting external sphincter contraction
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