1. Structure of the Bladder:
1.1. Parts:
1.1.1. Fundus (body) Neck (posterior urethra)
1.2. Urine:
1.2.1. passes from the kidneys to the bladder through the ureters
1.3. Ureters:
1.3.1. enter the bladder bilaterally at a location toward its base and close to the urethra
1.4. Trigone:
1.4.1. the triangular area bounded by the ureters and the urethra
2. Four Layers of the Bladder
2.1. Outer Serosal Layer
2.1.1. Covers upper surface; is continuous with the peritoneum
2.2. Detrusor Muscle
2.2.1. A network of smooth muscle fibers
2.3. Submucosal Layer
2.3.1. Loose connective tissue
2.4. Inner Mucosal Lining
2.4.1. Transitional epithelium
3. Three Main Levels of Neurologic Control of Bladder Function
3.1. Spinal cord reflex centers
3.1.1. Sacral (S1 through S4) and thoracolumbar (T11 through L2)
3.2. Micturition center in the pons
3.3. Cortical and subcortical centers
4. Storage and Emptying of Urine
4.1. Involves involuntary (autonomic nervous system) and voluntary control (somatic nervous system)
4.1.1. The parasympathetic nervous system promotes bladder emptying.
4.1.2. The sympathetic nervous system promotes bladder filling.
4.2. Striated muscles in the external sphincter and pelvic floor provide for voluntary control of urine.
5. ANS Drugs
5.1. Nicotinic Receptors
5.1.1. Sympathetic neurons
5.1.2. Increase bladder storage
5.2. Muscarinic Receptors
5.2.1. Inhibit sympathetic neurons
6. Urine Tests and Studies
6.1. Laboratory and Radiographic Studies
6.1.1. Urine tests and x-rays
6.2. Urodynamic Studies
6.2.1. Uroflowmetry Cystometry Urethral pressure profile Sphincter electromyography
6.2.2. Ultrasound bladder scan
7. Detrusor muscle weakness results in decreased void pressure and therefore greater volume left in the bladder
8. Signs of Outflow Obstruction and Urine Retention:
8.1. Bladder distention Hesitancy Straining when initiating urination Small and weak stream Frequency Feeling of incomplete bladder emptying Overflow incontinence
9. Common Causes of Neurogenic Bladder
9.1. Stroke and advanced age Parkinson disease Spinal cord injury Injury to the sacral cord or spinal roots Radical pelvic surgery Diabetic neuropathies Multiple sclerosis
9.2. Neurogenic Bladder Disorders
9.2.1. Spastic Bladder Dysfunction
9.2.1.1. Failure to store urine
9.2.1.2. Neurologic lesions above level of the sacral cord allow neurons in the micturition center to function reflexively without control from the CNS centers.
9.2.2. Flaccid Bladder Dysfunction
9.2.2.1. Bladder emptying is impaired
9.2.2.2. Neurologic disorders affect motor neurons in the sacral cord or peripheral nerves that control detrusor muscle contraction and bladder emptying
9.3. Goals of Treatment for Neurogenic Bladder Disorders
9.3.1. Prevent bladder overdistention Prevent urinary tract infections Prevent potentially life-threatening renal damage Reduce the undesirable social and psychological effects of the disorder
9.3.2. Treatments for Neurogenic Bladder Disorders
9.3.2.1. Catheterization Bladder retraining Pharmacologic manipulation Surgical procedures
10. Incontinence
10.1. Types of Incontinence
10.1.1. Stress Incontinence
10.1.1.1. Involuntary loss of urine during coughing, laughing, sneezing, or lifting
10.1.1.2. Increases intra-abdominal pressure
10.1.2. Urge Incontinence
10.1.2.1. Involuntary loss of urine associated with a strong desire to void (urgency)
10.1.3. Overflow Incontinence
10.1.3.1. Involuntary loss of urine that occurs when intravesicular pressure exceeds the maximal urethral pressure because of bladder distention in the absence of detrusor activity
10.1.4. Mixed Incontinence
10.1.4.1. Combination of stress and urge incontinence
10.2. Treatment Options for Incontinence
10.2.1. Management depends on the type of incontinence, accompanying health problems, and the person’s age.
10.2.2. Behavioral and pharmacological measures
10.2.3. Exercises to strengthen the pelvic muscles
10.2.4. Surgical correction
10.2.5. Noncatheter devices to obstruct urine flow or collect urine
10.2.6. Indwelling catheters
10.2.7. Self-catheterization
11. Bladder Cancer
11.1. Signs
11.1.1. Increased frequency
11.1.2. Urgency
11.1.3. Dysuria
11.1.4. Hematuria
11.2. Cancerous Lesion Types
11.2.1. Superficial Invasive
11.3. Diagnostic Measures for Cancer of the Bladder:
11.3.1. Cytologic studies
11.3.2. Excretory urography
11.3.3. Cystoscopy
11.3.4. Biopsy
11.3.5. Ultrasonography
11.3.6. CT scans
11.3.7. MRI
11.4. Treatment Methods for Bladder Cancer
11.4.1. Treatment methods depend on
11.4.1.1. The cytologic grade of the tumor
11.4.1.2. The lesion’s degree of invasiveness
11.4.2. Methods include
11.4.2.1. Surgical removal of the tumor
11.4.2.2. Radiation therapy
11.4.2.3. Chemotherapy