Urinary Bladder Anatomy and Physiology

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Questions and Answers

Which imaging technique is primarily used to confirm the diagnosis of a urinary bladder rupture?

Plain x-ray

IVU

Retrograde cystogram (correct)

CT-scan

What is the most common cause of acute urinary retention in males?

Bladder outlet obstruction (correct)

Urethral stricture

Acute urethritis

Phimosis

In cases of extraperitoneal rupture, what complication is commonly seen?

Pelvic hematoma with abscess formation (correct)

Peritonitis

Acute urinary retention

Urinary incontinence

What is the first line of treatment for chronic urinary retention?

Urethral catheterization Signup and view all the answers

Which of the following is NOT a common cause of urinary retention?

Hyperparathyroidism Signup and view all the answers

What treatment is indicated for an intraperitoneal rupture of the urinary bladder?

Surgical intervention Signup and view all the answers

Which symptom typically indicates acute urinary retention?

Persistent suprapubic pain Signup and view all the answers

What is the recommended management for overflow incontinence resulting from neglected chronic retention?

Urethral catheter insertion Signup and view all the answers

In which demographic are bladder stones most commonly found?

Adult males and male children in poor countries Signup and view all the answers

Which symptom is most indicative of a bladder stone in young boys?

Screaming and pulling of the penis Signup and view all the answers

What is the primary function of urodynamic studies?

Evaluate detrussor and sphincter function Signup and view all the answers

Which of the following is NOT a method of investigation for bladder stones?

Electromyography of the detrusor Signup and view all the answers

What characterizes cystometry in evaluating neurogenic bladders?

Low capacity and high pressure indicates a spastic bladder Signup and view all the answers

Which complication is associated with vesical stones?

Hematuria Signup and view all the answers

What is the typical measurement for urine flow rate in males?

20 ml/sec Signup and view all the answers

Which treatment is most appropriate for managing bladder stones?

Cystoscopic vesicolithotomy Signup and view all the answers

What is the normal capacity of the bladder in milliliters?

400-500 ml Signup and view all the answers

What is a common associated condition with bladder extrophy?

Vesicoureteral reflux (VUR) Signup and view all the answers

Which type of traumatic bladder rupture is more common?

Extraperitoneal rupture Signup and view all the answers

Which two components must coordinate for normal bladder function?

Motor and sensory components of somatic and autonomic nervous system Signup and view all the answers

What surgical procedure is often performed for bladder closure in patients with bladder extrophy?

Iliac osteotomy Signup and view all the answers

What is a clinical feature most commonly associated with bladder trauma?

Gross hematuria Signup and view all the answers

Which type of trauma is least likely to cause bladder injury?

Penetrating trauma from a knife wound Signup and view all the answers

In which population is bladder extrophy more prevalent?

Males (4:1) Signup and view all the answers

What is the normal urethral pressure range measured during profilometry?

80-120 cm H2O Signup and view all the answers

In a patient with a lower motor neuron lesion, which characteristic is most likely to be observed?

Low pressure, high capacity Signup and view all the answers

Which treatment is suitable for a type 3 neurogenic bladder classification?

Adrenergic antagonist Signup and view all the answers

What distinguishes type 1 urodynamic classification?

High muscle tone, low sphincter tone Signup and view all the answers

Which of the following medications is classified as a cholinergic antagonist?

Oxybutynin Signup and view all the answers

In relation to neurogenic bladder classification, what symptom is associated with an upper motor neuron lesion?

High pressure Signup and view all the answers

Which statement accurately describes the use of urodynamic studies?

They can identify type of distractor instability. Signup and view all the answers

What is the primary function of the cholinergic receptors in relation to the urinary bladder?

They control detrussor muscle action. Signup and view all the answers

Study Notes

Surgical Anatomy of the Urinary Bladder

Hollow muscular organ serving as a urine reservoir.
Lined with transitional epithelium; dome covered by peritoneum.
Normal bladder capacity ranges from 400-500 ml.

Physiology of Bladder Function

Requires coordination of somatic and autonomic nervous systems.
Involves interplay between detrusor muscle and sphincter muscles.
Comprises two sphincter components:
- Internal sphincter at bladder neck.
- External sphincter in prostatic & membranous urethra (male) and mid-urethral zone (female).

Bladder Exstrophy

Congenital anomaly exposing the bladder on the lower abdominal wall, occurring in 1:50,000 live births (male to female ratio 4:1).
Linked to failures in cloacal membrane retraction.
Associated conditions include VUR, inguinal hernia, and epispadias.
Treatment includes bladder closure with iliac osteotomy and eventual reconstruction of bladder neck and sphincter.

Bladder Trauma

Etiologies include blunt trauma (like pelvic fractures) and iatrogenic injuries during procedures.
Two types of rupture:
- Intraperitoneal rupture (20%): caused by blows to a distended bladder.
- Extraperitoneal rupture (80%): due to blunt trauma or surgical damage.

Clinical Features of Bladder Trauma

Symptoms include gross hematuria, pelvic/lower abdominal pain.
Physical examination may reveal tenderness in the lower abdomen and suprapubic area.
Signs of acute abdomen may appear with intraperitoneal rupture.

Investigations for Bladder Trauma

Initial assessment via plain X-ray for pelvic fractures; IVU for urine leaks; retrograde cystogram for confirmation; CT scan for detailed assessment.

Treatment of Bladder Trauma

Manage hemodynamics and shock initially.
Extraperitoneal rupture generally requires catheter drainage; surgical intervention needed for larger blood clots or bladder neck injuries.
Intraperitoneal rupture necessitates surgical repair.

Complications of Bladder Trauma

Extraperitoneal rupture may lead to pelvic hematoma and abscess.
Intraperitoneal rupture can result in peritonitis.
Incontinence may occur with bladder neck involvement.

Urinary Retention

Definition: inability to pass urine; can be acute or chronic.
Acute retention causes vary: male (bladder outlet obstruction, urethral stricture, acute urethritis, phimosis) and female (retroverted uterus, rare bladder neck obstruction).
Both genders: blood clots, urethral stones, neurogenic bladders, among others.

Clinical Features of Urinary Retention

No urine output for several hours; suprapubic pain is common.
Palpable, tender bladder noted during examination.

Treatment of Urinary Retention

Urethral catheterization is first-line; suprapubic drainage if necessary.
Address underlying causes; chronic retention presents risks of upper tract dilatation.

Vesical Stones

Most prevalent in adult males and male children in developing countries.
Can be primary (from kidneys) or secondary (due to infections or obstructions).
Mostly consist of mixed stones.

Clinical Features of Vesical Stones

May be asymptomatic; symptoms include frequency, incomplete emptying, terminal hematuria, and pain during urination.

Investigations for Vesical Stones

Urinalysis may show pus, crystals, or RBCs.
Imaging such as KUB and ultrasound recommended; cystoscopy is both diagnostic and therapeutic.

Treatment of Vesical Stones

Address underlying issues like BPH or neurogenic bladder.
Stone treatment options: cystoscopic or open vesicolithotomy.

Urodynamic Study

Assesses detrusor and sphincter function through:
- Uroflowmetry: measures urine flow rate.
- Cystometry: evaluates bladder capacity and sensation to void.
- Profilometry: measures urethral sphincter pressure.
- EMG of sphincter: examines electrical activity.

Neurogenic Bladder Classification

Upper motor neuron lesions cause spastic neurogenic bladder: high pressure, low capacity; symptoms include frequency and incontinence.
Lower motor neuron lesions result in flaccid neurogenic bladder: low pressure, high capacity; symptoms include retention and overflow incontinence.

Urodynamic Classification

Classifies condition based on detrusor and sphincter states:
- Type 1: high muscle tone, low sphincter tone (incontinence).
- Type 2: high sphincter tone (retention).
- Type 3: low muscle tone, normal/high sphincter tone (retention).
- Type 4: low muscle tone, low sphincter tone (incontinence).

Treatment Approaches for Neurogenic Bladder

Medications target cholinergic (detrusor) and adrenergic (sphincter) receptors.
Possible interventions include catheterization and clean intermittent catheterization (CIC) for management.

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Description

Explore the surgical anatomy and physiology of the urinary bladder in this quiz. Learn about the bladder's structure, its capacity, and the coordination needed for normal bladder function. Test your understanding of its muscular components and their roles in urine storage and release.