Neurogenic Bladder Overview

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Questions and Answers

What characterizes a flaccid bladder following an acute spinal cord lesion?

Regular complete evacuation of bladder

Urinary retention and inactive bladder (correct)

Frequent uncontrolled voiding

Immediate recovery of bladder function

What occurs in a spastic hyperactive bladder after stabilization?

Total loss of bladder control

Frequent complete emptying of the bladder

Permanent urinary retention

Involuntary yet regular complete bladder evacuation (correct)

Which condition is associated with an uninhibited bladder?

Injury below the spinal cord region

Stroke, multiple sclerosis, or head trauma (correct)

Acute spinal cord injury causing flaccidity

Complete absence of bladder sensitivity

What results from a lesion above the centers controlling the bladder?

Increased bladder urgency and frequency Signup and view all the answers

The term 'automatic bladder' refers to which situation?

Involuntary voiding with regular evacuation Signup and view all the answers

What are the two main roles of the lower urinary tract?

Urine storage and efficient voiding Signup and view all the answers

Which of the following is NOT involved in controlling bladder function?

Peripheral vascular system Signup and view all the answers

During the storage phase of urine, which pathway is activated?

Sympathetic pathway Signup and view all the answers

What initiates the voiding of urine from the bladder?

Activation of the parasympathetic pathway Signup and view all the answers

Which nerve is primarily responsible for the contraction of the detrusor muscle during voiding?

Pelvic nerve Signup and view all the answers

In bladder control, what role does the pudendal nerve primarily serve?

Coordinating contraction of the external urethral sphincter Signup and view all the answers

Which of the following accurately encapsulates the functioning of the bladder and sphincter?

They are controlled in a reciprocal manner. Signup and view all the answers

What occurs when the parasympathetic pathway is activated during micturition?

Contraction of detrusor muscle Signup and view all the answers

What is a characteristic of lesions in the afferent fibers of the reflex arc?

Retention of urine with a huge bladder size Signup and view all the answers

Which statement best describes motor lesions in the efferent fibers?

Retention of urine with a moderate size of the bladder Signup and view all the answers

What is a feature of lesions affecting both afferent and efferent fibers?

Autonomous bladder with irregular evacuation Signup and view all the answers

Which symptom is associated with a tonic bladder due to lesions in the afferent fibers?

Dribbling of urine due to overflow Signup and view all the answers

What is commonly required with motor lesions in the efferent fibers of the bladder?

Frequent catheterization Signup and view all the answers

Study Notes

Normal Function of the Lower Urinary Tract

The lower urinary tract (LUT) consists of the urinary bladder, urethra, and periurethral striated muscles.
Main functions include continence (storage of urine) and micturition (voiding urine).
These functions are regulated by higher cortical centers, the brainstem pontine micturition center, and spinal cord neural circuits.

Control Mechanisms

Sympathetic Nervous System: Engages via the hypogastric nerve (L1,2), facilitating bladder relaxation during storage.
Parasympathetic Nervous System: Activated through the pelvic nerve (S2,3,4), promoting contraction of the detrusor muscle during voiding.
Somatic System: Involves the pudendal nerve (S2,3,4) for external urethral sphincter (EUS) control.

Bladder and Sphincter Regulation

During storage, urine retention is ensured by sympathetic pathways and coordinated contraction of the EUS.
Voiding is initiated by parasympathetic activation, causing detrusor contraction and relaxation of the urethral sphincters.

Lesions and Their Effects

Lesions at Reflex Arc Level (Lower Motor Neuron Lesions - LMNL):
- Afferent Fiber Lesions:
  - Results in a sensory a tonic bladder with loss of fullness sensation.
  - Causes urine retention, bladder overdistension, and overflow dribbling.
- Efferent Fiber Lesions:
  - Leads to a motor a tonic bladder preserving fullness sensation but inability to voluntarily evacuate.
  - Prone to overflow dribbling; catheterization often required.
- Combined Lesions:
  - Characterized as an autonomic bladder with irregular, involuntary evacuation relying on myogenic contraction.
Lesions Above Reflex Arc Level (Upper Motor Neuron Lesions - UMNL):
- Flaccid Bladder:
  - Seen in acute spinal cord lesions; presents with urinary retention and bladder inactivity.
- Spastic Hyperactive Bladder:
  - Occurs in chronic spinal cord lesions; results in frequent uncontrollable voiding and eventually evolves into an automatic bladder.
- Uninhibited Bladder:
  - May arise from cortical lesions such as in strokes or multiple sclerosis, leading to increased urinary frequency and urgency due to lack of inhibitory impulses.

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Description

This quiz explores the normal functions of the lower urinary tract, focusing on the role of the urinary bladder, urethra, and periurethral striated muscles in maintaining continence and efficient micturition. It provides an insightful look into the mechanisms of bladder function and associated conditions. Perfect for those interested in urology and neurogenic disorders.