Discussion Question
yury12082Chapter 35: Disorders of the Bladder and Lower Urinary Tract
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Structure of the Bladder
Parts
Fundus (body)
Neck (posterior urethra)
Urine: passes from the kidneys to the bladder through the ureters
Ureters: enter the bladder bilaterally at a location toward its base and close to the urethra
Trigone: the triangular area bounded by the ureters and the urethra
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Four Layers of the Bladder
Outer Serosal Layer
Covers upper surface; is continuous with the peritoneum
Detrusor Muscle
A network of smooth muscle fibers
Submucosal Layer
Loose connective tissue
Inner Mucosal Lining
Transitional epithelium
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Three Main Levels of Neurologic Control of Bladder Function
Spinal cord reflex centers
Sacral (S1 through S4) and thoracolumbar (T11 through L2)
Innervation
Pelvic nerve innervates detrusor.
Pudendal nerve
Hypogastric
Micturition center in the pons
Cortical and subcortical centers
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Question #1
Is the following statement True or False?
The micturition reflex involves both sympathetic and parasympathetic input.
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Answer to Question #1
True
Rationale: The reflex is both conscious and unconscious.
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Storage and Emptying of Urine
Involves involuntary (autonomic nervous system) and voluntary control (somatic nervous system)
The parasympathetic nervous system promotes bladder emptying.
The sympathetic nervous system promotes bladder filling.
Striated muscles in the external sphincter and pelvic floor provide for voluntary control of urine.
Low-pressure urine storage
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ANS Drugs
Nicotinic Receptors
Sympathetic neurons
Increase bladder storage
Muscarinic Receptors
Inhibit sympathetic neurons
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Urine Tests and Studies
Laboratory and Radiographic Studies
Urine tests and x-rays
Urodynamic Studies
Uroflowmetry
Cystometry
Urethral pressure profile
Sphincter electromyography
Ultrasound bladder scan
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Question #2
Increased PVR volumes is the result of _______________.
Hematuria
Detrusor muscle weakness
Infection
Drug treatment
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Answer to Question #2
B. Detrusor muscle weakness
Rationale: Detrusor muscle weakness results in decreased void pressure and therefore greater volume left in the bladder.
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Alteration in Bladder Function
Types
Urinary obstruction with retention or stasis of urine
Urinary incontinence with involuntary loss of urine
Causes
Structural changes in the bladder, urethra, or surrounding organs
Impairment of neurologic control of bladder function
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Signs of Outflow Obstruction and Urine Retention
Bladder distention
Hesitancy
Straining when initiating urination
Small and weak stream
Frequency
Feeling of incomplete bladder emptying
Overflow incontinence
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Common Causes of Neurogenic Bladder
Stroke and advanced age
Parkinson disease
Spinal cord injury
Injury to the sacral cord or spinal roots
Radical pelvic surgery
Diabetic neuropathies
Multiple sclerosis
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Neurogenic Bladder Disorders #1
Spastic Bladder Dysfunction
Failure to store urine
Neurologic lesions above level of the sacral cord allow neurons in the micturition center to function reflexively without control from the CNS centers.
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Neurogenic Bladder Disorders #2
Flaccid Bladder Dysfunction
Bladder emptying is impaired.
Neurologic disorders affect motor neurons in the sacral cord or peripheral nerves that control detrusor muscle contraction and bladder emptying.
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Goals of Treatment for Neurogenic Bladder Disorders
Prevent bladder overdistention
Prevent urinary tract infections
Prevent potentially life-threatening renal damage
Reduce the undesirable social and psychological effects of the disorder
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Treatments for Neurogenic Bladder Disorders
Catheterization
Bladder retraining
Pharmacologic manipulation
Surgical procedures
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Question #3
Which of the following is not a cause of neurogenic bladder?
Parkinson disease
Spinal cord injury
Alzheimer disease
Injury to the sacral cord or spinal roots
Radical pelvic surgery
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Answer to Question #3
C. Alzheimer disease
Rationale: Alzheimer disease is primarily a cognitive condition, not motor related.
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Types of Incontinence #1
Stress Incontinence
Involuntary loss of urine during coughing, laughing, sneezing, or lifting
Increases intra-abdominal pressure
Urge Incontinence
Involuntary loss of urine associated with a strong desire to void (urgency)
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Types of Incontinence #2
Overflow Incontinence
Involuntary loss of urine that occurs when intravesicular pressure exceeds the maximal urethral pressure because of bladder distention in the absence of detrusor activity
Mixed Incontinence
Combination of stress and urge incontinence
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Treatment Options for Incontinence
Management depends on the type of incontinence, accompanying health problems, and the person’s age.
Behavioral and pharmacological measures
Exercises to strengthen the pelvic muscles
Surgical correction
Noncatheter devices to obstruct urine flow or collect urine
Indwelling catheters
Self-catheterization
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Elderly Incontinence
Overall capacity of the bladder is reduced.
Urethral closing pressure is reduced.
Detrusor muscle function declines with aging.
To larger PVR volumes
Advancing age
Restricted mobility
Increased medication
Comorbid illness
Infection
Stool impaction
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Bladder Cancer
Signs
Increased frequency
Urgency
Dysuria
Hematuria
Cancerous Lesion Types
Superficial
Invasive
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Diagnostic Measures for Cancer of the Bladder
Cytologic studies
Excretory urography
Cystoscopy
Biopsy
Ultrasonography
CT scans
MRI
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Treatment Methods for Bladder Cancer
Treatment methods depend on
The cytologic grade of the tumor
The lesion’s degree of invasiveness
Methods include
Surgical removal of the tumor
Radiation therapy
Chemotherapy
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