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Physiology of micturiton
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Physiology of micturiton


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  • 2.  Spinal Reflex Its reflex activity at sacral plexus Facilitated and inhibited by brain Facilitated by PMC and inhibited by area in mid brain
  • 3. Filling PhaseEmptying Phase
  • 4.  Sympathetic nerve inhibit parasympathetic supply Sympathetic nerves causes relaxation and expansion of detrusor muscles Sympathetic nerves constrict internal urethral sphincter
  • 5. Bladder filing Pudendal nerve gets excitedContraction of external urethral sphicterContraction of internal and external sphinctermaintains continence
  • 6. Pudendal nerve relaxes levator aniAlso relaxes external urethral sphincterSympathetic system relaxes internal urethralsphincterParasympathetic system causes contraction of thedetrusor musclesBladder pressure overcomes urethral pressure
  • 7. 80IntravesicalPressure 60 0(cm 40water) 20 100 200 300 400 500 Intravesical volume (ml)
  • 8. Neurogenic bladder is a term applied to amalfunctioning urinary bladder due toneurogenic dysfunction or insult emanatingfrom internal or external trauma ,disease or injury.
  • 9. Brain lesionsShy drager syndromeBrain tumorParkinsonism diseaseHydrocephalusCerebral palsy
  • 10. Spinal cord lesionsTrauma to the spineHerniated discMyelomeningocele
  • 11. Peripheral nerve lesionsGuillian-Barry syndromeSever herpes in in genitoanal areaPernicious anaemiaNeurosyphilis
  • 12.  Flaccid or Atonic Bladder Spastic or Reflex Bladder Uninhibited Bladder Sensorimotor Paralytic Bladder
  • 13. Occurs after acute spinal cord injury.The bladder fails to contract resulting in urinary retention
  • 14. Occurs when there is a spinal cord injury abovethe level of S2-S4.It results in frequent uncontrolled voiding due tobladder spasms and a lack of sensation.
  • 15. Urinary frequency and urgency resultingfrom changes in the brain.This may be caused by conditions such asstroke, head injury or Multiple Sclerosis.
  • 16. Inability to empty the bladder because of damage to the peripheral nervous system.It can be caused by conditions such as diabetes mellitus or extensive pelvic surgery.
  • 17.  Follow a regular schedule Empty your bladder completely each time Prevention of UTI
  • 18. Intermittent catheterizationIndwelling catheterExternal condom catheter for menSuprapubic catheterization
  • 19. Clean Technique-Clean technique doesnot require the use of sterile catheters or gloves.wash your hands and genital area beforeinserting a new catheter
  • 20. Aseptic TechniqueUse a sterile catheter and it will remain sterilethroughout the catheterizationInsert the catheter through aprotective sleeve or use sterile gloves
  • 21. Sterile TechniqueTo achieve a sterile technique, you will use acompletely sterile setting.This includes sterile gloves, forceps, gown andmask.
  • 22. This type of catheter is held in the bladderby an inflatable balloon and it providescontinuous drainage.Long term indwelling catheters aretypically replaced by a healthcareprofessional every 10-12 weeks.
  • 23.  Short term  Long term (14-28 days) (12 weeks) All-siliconPolyvinyl chlorideLatex Silicon elastometer coated Hydrogel coatedTeflon
  • 24. Complications of indwelling catheters may include urinary tract or kidney infections, blood infections (septicemia), urethral injury, skin breakdown, bladder stones, and/or hematuria.
  • 25. A suprapubic catheter is an indwellingcatheter that is placed directly into thebladder through the skin above the pubicbone.The insertion site (opening on the skin), andthe tube, must be cleansed daily with soapand water
  • 26. No risk of urethral damageNo risk of prostatitis and epididymo-orchitisCan be clamped intermittently to see if voidingoccurs.
  • 27. Less chances of UTIMay require distal urethralsphincterectomy
  • 28. These stimulates the anterior nerve rootsof S2,S3 and S4 nerves and helps invoiding the bladder.
  • 29. Few patients train themselves to initiatethe voiding reflex by stroking or pinchingon medial side of the thigh and initiate thereflex
  • 30. UTIRenal failureBladder stonesUrine leakage or incontinenceBladder cancer
  • 31. Keep skin cleanUse proper techniques closed system cathetersDrink plenty of fluids Indwelling Catheter – 15 glasses of water Condom and Intermittent Catheterization – 8-10 glasses of waterEmpty bladder on a regular schedule
  • 32. Have a regular urologic check-upRenal scan or ultrasound X ray-KUBKnow the warning signs of infection cloudy urine bad smelling urine (foul odor); and blood in the urine (pink or red urine).
  • 33. THANK YOU