The document discusses the anatomy and neural control of the bladder. It describes the layers of muscle that compose the bladder wall and urethra. Both the internal and external urethral sphincters are discussed as well as their innervation. Five reflex loops or centers are described that coordinate the filling and voiding of the bladder involving brain, spinal cord and peripheral nerves. Different types of neurogenic bladder dysfunction are also summarized based on the level of nervous system lesion.
This presentation describes the common conditions, anatomy and the ideal ways to do and perform nerve conduction studies in lower limbs. It is nicely depicted with self explanatory pictures.
Physiotherapy management of spasticity using diffrent modalities as well as manual techniques is described along with possible dosage ijn clinical use is also menstined.
This presentation describes the common conditions, anatomy and the ideal ways to do and perform nerve conduction studies in lower limbs. It is nicely depicted with self explanatory pictures.
Physiotherapy management of spasticity using diffrent modalities as well as manual techniques is described along with possible dosage ijn clinical use is also menstined.
Functional Anatomy and Innervation of Urinary TractSiewhong Ho
Dr Ho Siew Hong lectured on the anatomy and innervation of the urinary tract with special emphasis on clinical relevance during the 3rd Japan ASEAN Conference 08
Urinary incontinence is loss of bladder control. Symptoms can range from mild leaking to uncontrollable wetting. It can happen to anyone, but it becomes more common with age.
Most bladder control problems happen when muscles are too weak or too active. If the muscles that keep your bladder closed are weak, you may have accidents when you sneeze, laugh or lift a heavy object. This is stress incontinence. If bladder muscles become too active, you may feel a strong urge to go to the bathroom when you have little urine in your bladder. This is urge incontinence or overactive bladder. There are other causes of incontinence, such as prostate problems and nerve damage.
an overview of the ascending tract of the spinal cord....an anatomical approach to understand the somato-sensory pathway.
Prepared as a class presentation .
The all the content in this profile is completed by the teachers, students as well as other health care peoples.
thank you, all the respected peoples, for giving the information to complete this presentation.
this information is free to use by anyone.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. ANATOMY
• Detrusor muscle:
– is a layer of the urinary bladder wall made of smooth
muscle fibers arranged in spiral, longitudinal, and
circular bundles.
– The smooth muscle of the bladder, the detrusor is
innervated by sympathetic nervous system fibers from
the lumbar spinal cord and parasympathetic fibers from
the sacral spinal cord.
3. Urethral sphincters
• External sphincter (sphincter urethrae):
– located at the bladder's distal inferior end in females and inferior
to the prostate (at the level of the membranous urethra) in males
– It is a secondary sphincter to control the flow of urine through the
urethra.
– Unlike the internal sphincter muscle, the external sphincter is
made of skeletal muscle,
– It is under voluntary control of the somatic nervous system.
– It is innervated by pudendal nerves
• Internal sphincter muscle of urethra:
– It is located at the bladder's inferior end and the urethra's
proximal end at the junction of the urethra with the urinary
bladder.
– The internal sphincter is a continuation of the detrusor muscle
and is made of smooth muscle,
– it is under involuntary or autonomic control.
– This is the primary muscle for prohibiting the release of urine.
4. • There are three layers of muscle that are known to control urine
flow through the urethra;
– an inner band of longitudinal smooth muscle
– a middle band of circular smooth muscle
– an external band of striated muscle called the rhabdosphincter.
• The urethra is controlled by the
sympathetic, parasympathetic, and somatic divisions of the
peripheral nervous system.
• The sympathetic innervation (nerve supply) comes from the
sympathetic preganglionic neurons located in the upper lumbar
spinal cord along the hypogastric nerve and terminates in the
longitudinal and circular smooth muscle layers in the urethra.
• The parasympathetic nerve supply comes from the
parasympathetic preganglionic neurons in the sacral spinal cord
and also terminates in the longitudinal and circular smooth muscle
layers.
• The somatic nerve supply arises from the urethral sphincter motor
neurons in the ventral horn of the sacral spinal cord; better known
as Onuf’s nucleus. The pudendal nerve that extends from Onuf’s
nucleus, connects directly to the rhabdosphincter muscle to
control micturation
5. PARASYMPATHETIC:
CENTRE: S2-S4 in intermediolateral column
SUPPLY THROUGH: pelvic splanchnic nerves
END IN : GANGLIA IN BLADDER WALL
NEUROTRANSMITTER : ACh VIA M2, M3
FUNCTION:
Cholinergic preganglionic neurons within the intermediolateral sacral
cord send axons to ganglionic cells within the pelvic plexus and the
bladder wall.
Postganglionic neurons within the bladder wall and pelvic plexus release
acetylcholine, which activates cholinergic receptors M2 and M3 on the
detrusor smooth muscle cells initiates
Bladder detrusor contraction
Internal sphincter relaxation
6.
7. • SYMPATHETIC:
CENTRE: T11-L2 intermediolateral column
SUPPLY THROUGH:
sympathetic chain ganglia-prevertebral gangliahypogastric and pelvic plexus –inferior mesentric
ganglion –post ganglionic fibres
FUNCTION:
– innervate the bladder via short adrenergic neurons.
– Via β-adrenergic receptors -inhibition and relaxation of
the detrusor muscle.
– Through alpha receptors causes Contraction of internal
sphincter
– Facilitate bladder storage and continence
8.
9. • SOMATIC :
CENTRE: ONUF’S NUCLEUS S2-S4
SUPPLY THROUGH: PUDENDAL NERVES
FUNCTION : CONTROLS THE EXTERNAL
SPHINCTER
13. LOOP 1- cerebral loop
• involving the brainstem, cerebral cortex,
and basal ganglia structures, which
initiates and inhibits switching between
filling and voiding states.
15. • INTERRUPTION OF THIS LOOP OCCURS IN
•
•
•
•
•
•
CVA
BRAIN TUMOUR
HEAD INJURY
MULTIPLE SCLEROSIS
PARKINSONS DISEASE
INTERRUPTION OF THIS LOOP RESULTS IN UNINHIBITED
BLADDER
16. LOOP 2- Cord loop
• From brainstem structures to the conus
medullaris), which coordinates detrusor and
sphincter contract ion and relaxation.
17. LOOP 2
• BRAIN STEM MICTURITION CENTRE
RETICULOSPINAL TRACT
LATERAL AND POSTERIOR COLUMN
DETRUSOR
18. • THIS LOOP IN AFFECTED IN
•
•
•
•
•
SP CORD TRAUMA
MULTIPLE SCLEROSIS
SPINAL CORD TUMOUR
ARACHNOIDITIS
PARTIAL INTERRUPTION RESULTS IN
DETRUSOR HYPER REFLEXIA
UNABLE TO GENERATE VOLUNTARY VOIDING
19. LOOP-3 Detrusor reflex loop
• detrusor afferents to pudendal motor
neurons, which causes sphincter relaxation
when the detrusor is active.
20. LOOP-3
• DETRUSOR MUSCLE CONTRACTION
• AFFERENTS TO PUDENTAL MOTOR NEURONS
• INHIBITION OF INTERNAL SPINCTER
• SPINCTER RELAXATION
21. LOOP-4 Urethral reflex loop
• from urethral afferents to pudendal motor
neurons), which maintains the sphincter
tone when the detrusor is inactive.
23. LOOP -5 Corticospinal pathways
• from motor cortex to pudendal motor
neurons, which are concerned with the
voluntary control of the sphincters and pelvic
floor.
24. Neurotransmitors
• The sympathetic storage reflex or pelvic-to-hypo-gastric
reflex is initiated when the bladder swells. Stretch
receptors cause postganglionic neurons to release
norepinephrine (NE). NE causes the bladder to relax and
the urethra to contract, thus preventing urine loss.
• The somatic storage reflex or the pelvic-to-pudendal or
guarding reflex is initiated when one laughs, sneezes, or
coughs, which causes increased bladder pressure.
Glutamate is the primary excitatory transmitter for the
reflex. Glutamate activates NMDA and AMPA receptors
which produce action potentials. These action potentials
activate the release of acetylcholine causing the
rhabdosphincter muscle fibers to contract. When the
guarding reflex does not function normally, SUI occurs
25.
26. SPINAL REFLEX ARC
• AFFERENT ARC:
– Sensation of stretch arising from bladder wall travels
through the parasympathetic nerves to the center for
micturition
• DETRUSOR CENTER OR SACRAL PARASYMPATHETIC NUCLEUS
– sacral segments S2,S4 of the spinal cord.
• EFFERENT ARC (PARASYMPATHATIC)
– travels through the pelvic nerves to the pelvic plexus;
short postganglionic fibers travel from the plexus to the
detrusor muscle.
27.
28. HIGHER CENTERS
• CORTICAL CENTERS:
– Situated in
• Medial frontal lobe
• Cingulate gyrus
• Corpus collosum
• cortical input is inhibitory on micturition reflexes.
29. • Subcortical centers:
– thalamic nuclei
– limbic system,
– Red nucleus
– Substantia nigra
– Hypothalamus
– Subthalamic nucleus.
• Cerebellum :
– anterior vermis of the cerebellum
– fastigial nucleus are concerned with micturition.
30. • Lesions resulting from tumors, aneurysms, or
cerebrovascular disease remove the cortical
inhibition, which results in increased excitatory
input to the brainstem, facilitation of the
micturition reflex, and the clinical appearance of
urinary frequency and urgency.
• Descending fibers in the corticospinal tracts
emanate from the cortical region to innervate
sacral parasympathetic neurons and the motor
nucleus controlling voluntary sphincter function
31. PONTINE MICTURITION CENTERS
(Barrington's nucleus):
– pontomesencephalic reticular formation micturition
center (located in the locus ceruleus, pontomesencephalic
gray matter, and nucleus tegmentolateralis dorsalis).
– collection of cell bodies located in the rostral pons in the
brainstem involved in the supraspinal regulation of
micturition (urination).
– The PMC makes connections with other brain centers to
control micturition, including the medial frontal
cortex, insular cortex, hypothalamus and periaqueductal
gray (PAG).
– The PAG in particular acts a relay station for ascending
bladder information from the spinal cord and incoming
signals from higher brain areas.
32.
33. Course from higher centres
• From the pontomesencephalic micturition center,
efferents to the spinal cord descend by way of
the reticulospinal tracts (located medially and
anteriorly in the anterior funiculus) to the
detrusor motor neurons in the intermediolateral
cell columns of the sacral gray matter (S2–S4).
• Efferents from the cortical and subcortical
micturition centers descend by way of the
pyramidal tracts to the pudendal nuclei (Onuf’s
nucleus) in the sacral spinal cord (S2–S4).
• The pudendal nerves, whose motor neurons are
located in the ventral horns of sacral segments
S2–S4, innervate the striated muscle around the
urethra
34. • Onuf’s nucleus
– It is a distinct group of neurons located in the ventral part
(laminae IX) of the anterior horn of the sacral region of the spinal
cord . It extends from S1 to S3 mainly in S2
– It is involved in the maintenance of micturition and defecatory
continence, as well as muscular contraction during orgasm.
– It contains motor neurons, and is the origin of the pudendal
nerve.
– The neurons of Onuf’s nucleus are responsible for controlling external
sphincter muscles of the anus and urethra.
– The dorsomedial subnucleus innervates the the ventrolateral subgroup
connects to the urethral striated sphincter (vonluntary sphincter) and
rectal striated sphincter
– Onuf’s nucleus controlled the ischiocavernosus and bulbocavernosus
muscles which function in penile erection and ejaculation in males.
– Neurotransmitters in Onuf's nucleus
– The motoneurons in Onuf’s nucleus contain a dense array of serotonin
and norepinephrine receptors and transmitters and are activated by
glutamate. When the 5-HT and NE receptors are stimulated, the
guarding reflex occurs to prevent voiding of the bladder caused by
unexpected abdominal pressure sneezing, coughing etc.
35.
36. • REGULATION OF MICTURITION:
– Micturition is a spino-bulbo-spinal reflex. In response to stretch,
afferent impulses are carried to the sacral spinal cord.
– Sacral cord projections to the PAG are relayed to the pontine
micturition center (Barrington's nucleus)
– The pontine micturition center is under the control of centers in
the forebrain.
– During bladder filling, neurons within the PMC are turned off.
– at a critical level of bladder distention, the afferent activity arising
from mechanoreceptors in the bladder wall switches the PMC on
and enhances its activity.
– neurons in the PMC send descending excitatory projections to
spinal parasympathetic preganglionic neurons innervating the
bladder and inhibitory interneurons regulating Onuf's nucleus.
– This activation results in relaxation of the urethra and contraction
of the bladder due to stimulation of parasympathetic and
inhibition of sympathetic outflow to the bladder, and the removal
of somatic activation of the external urethral sphincter. This
pattern of activity can also be elicited through the conscious
desire to void
37.
38.
39.
40. • There is a curious preservation of the Onuf nucleus
neurons in amyotrophic lateral sclerosis.
• The internal uretheral sphincter at the neck of the
bladder receives its innervation from the
intermediolateral column at the T12-L1 level, via
the sympathetic prevertebral plexus and the
hypogastric nerve
41. • In the infant, bladder function is purely reflex, but
with cortical maturation and the completion of
myelination inhibitory control over this reflex
develops, as well as voluntary regulation of the
external sphincter.
• Normal micturition requires intact autonomic and
spinal pathways, and cerebral inhibition and control
of the external sphincter must be normal
42. • Forebrain lesions may cause loss of voluntary bladder control, but do not
affect the spino-bulbo-spinal reflex mechanisms.
• Disruption of the bulbospinal pathway from the pontine micturition center
to the sacral cord, and lesions affecting the afferent and efferent
connections between the bladder and the conus medullaris may cause
severe disturbances in bladder function.
• The term neurogenic bladder refers to bladder dysfunction caused by
disease of the nervous system.
• Symptoms of bladder dysfunction are often among the earliest
manifestations of nervous system disease.
• Frequency, urgency, precipitate micturition, massive or dribbling
incontinence, difficulty in initiating urination, urinary retention, and loss of
bladder sensation may occur.
• One practical classification of neurogenic bladder dysfunction is based on
urodynamic criteria and includes the following types:
–
–
–
–
–
uninhibited,
Reflex
autonomous,
sensory paralytic
motor paralytic.
43.
44. Uninhibited neurogenic bladder
• there is a loss of the cortical inhibition of reflex
voiding,
• while bladder tone remains normal.
• Bladder distention causes contraction in
response to the stretch reflex.
• There is frequency, urgency, and incontinence
that are not associated with dysuria.
• Hesitancy may precede urgency.
• Bladder sensation is usually normal.
• There is no residual urine.
45. Reflex neurogenic bladder/SPASTIC/hyperreflexic
• lesions above the level of the sacral bladder center and
below the level of the pontomesencephalic micturition
center.
• occurs with severe myelopathy or extensive brain lesions
causing interruption of both the descending autonomic tracts
to the bladder and the ascending sensory pathways above the
sacral segments of the cord.
• UMN CUT OFF LMN INTACT
• associated with quadriplegia or paraplegia and in advanced
cases of multiple sclerosis
• Detrusor spinter synergia lost results in obstructed
voiding, an interrupted urinary stream, incomplete
emptying, and high intravesical pressures because the
sphincter fails to relax correctly .
• Upper urinary tract dilatation and kidney damage may
develop subsequently.
46. • Loss of the normal inhibition from higher centers results in
detrusor contraction during bladder filling.
• contractions occur spontaneously or may be provoked
by coughing or changing posture.(stress incontinence)
• detrusor becomes overactive, so there is urinary
frequency, urgency, urge incontinence (the patient is
unable to inhibit the detrusor reflex),
• inability to initiate micturition voluntarily.
• Small volumes of urine stimulate uninhibited detrusor
muscle contraction; the bladder capacity is reduced
but residual urine may be increased (increased
postmicturit ion residual volume).
• bulbocavernosus and superficial anal reflexes are
preserved.
• With lesions above the splanchnic out flow, bladder
fullness may induce a “mass reflex” with paroxysmal
hypertension, headaches, diaphoresis, and bradycardia.
47. Autonomous/FLACID neurogenic bladder
• is one without external innervation.
• seen with complete lesions below the T12 segment that
involve the conus medullaris and cauda equina. , S2-S4 motor or
sensory roots, or the peripheral nerves, and with congenital
anomalies such as spina bifida.
• It occurs with sacral myelomeningocele and tumors of the
conus medullaris–cauda equina region
• There is destruction of the parasympathetic supply.
• Sensation is absent
• There is no reflex or voluntary control of the bladder;
• contractions occur as the result of stimulation of the intrinsic neural
plexuses within the bladder wall.
• The amount of residual urine is large, but the bladder capacity is
not greatly increased
48. • urinary retention because the tone of the detrusor
muscle is abolished
• the bladder distends as urine accumulates. Inability
to initiate micturition,
• overflow incontinence, and increased residual urine
develop .
• There is associated saddle anesthesia with absence
of the bulbocavernosus and superficial anal
reflexes.
• Anal sphincter control is often similarly affected.
• The bladder capacity may greatly increase, and
• its walls may become fibrotic.
• A large residual urine volume may therefore occur
because of incomplete detrusor contractions.
49. Motor paralytic bladder
• develops when the motor nerve supply to the bladder is
interrupted.
• The bladder distends and decompensates,
• but sensation is normal.
• The residual urine and bladder capacity vary.
• Occurs in lumbar spinal stenosis, lumbosacral
meningomyelocele, or following radical hysterectomy or
abdominop erineal resect ion.
• In most of these cases, pat ients suffer from painful urinary
retention or imp aired bladder emptying.
• Residual urine is markedly increased.
• The bulbocavernosus and sup erficial anal reflexes are usually
absent , but sacral and bladder sensation are present .
50. Sensory paralytic bladder
• occur in tabes dorsalis, syringomyelia, or diabetes mellitus
• is found with lesions that involve the posterior roots or posterior
root ganglia of the sacral nerves, or the posterior columns of the
spinal cord.
• Sensation is absent, and there is no desire to void. He can void
voluntarily (motor intact)
• There may be distention, dribbling, and difficulty both in initiating
micturition and in emptying the bladder.
• There is a large amount of residual urine
• Urinary retention, overflow incontinence, or urinary tract
infection may be early symptoms.
• The bulbocavernosus and superficial anal reflexes may be absent ,
decreased, or present .