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Bladder Physiology & Obstruction Year 2 Revision Night Part One Bladder Anatomy & PhysiologyBladder Anatomy • Body – covered by rugae (folded lining) • Ureters – left and right, drains urine from kidneys into bladder • Urethra – urine leaves the bladder • Trigone – orifices of ureters and urethra, smooth walls • Function: • Storage of urine – 400-600ml • Expulsion of urineBladder Musculature • Detrusor muscle • Smooth muscle – allows for stretch as bladder fills • Sympathetic and parasympathetic innervation • Interna Urethral Sphincter • Male – circular smooth fibres, autonomic control • Female – functional sphincter, bladder neck and urethra • External Urethral Sphincter • Skeletal muscle • Voluntary controlBladder Vasculature • Arterial • Internal iliac arteries • Superior vesical branch • Venous • Vesical venous plexus • Internal iliac veins • Lymphatic drainage • External and internal iliac, sacral and common iliac lymph nodesPhysiology of Bladder Voiding • 4 main receptors involved: • Muscarinic (M3) receptor • Beta-adrenergic (B3) receptor • Alpha-adrenergic (A1) receptor • Nicotinic receptor • Controlled by CNS • Micturition centre in ponsBladder Physiology – Nerves • Pelvic nerve • Hypogastric Nerve • Parasympathetic • Sympathetic nerve • Releases ACh • Releases noradrenaline • Acts on M3 • Acts on B3 and a1 • Detrusor contraction • B3 = detrusor relaxation • A1 = internal sphincter contraction • Pudendal nerve (efferent) • Somatic nerve • Pelvic nerve (afferent) • Releases ACh • Somatic nerve • Comes from detrusor muscle • Acts on Nicotinic receptor • Stimulated when stretched • External sphincter contractionBladder NervesBladder Micturition Part Two Bladder ObstructionBladder Obstruction • Symptoms • Hesitancy • Sensation of incomplete emptying • Reduced stream volume • Post-void dribbling • Urgency • Frequency • nocturiaCauses • Benign prostatic hyperplasia • Urethral stricture • Prostate cancer • Pelvic prolapse • Bladder stones • Neurological disorder • Multiple sclerosis • Parkinson's diseaseBenign Prostatic Hyperplasia • Most common cause of outflow obstruction • Males • >50 years, smoking • LUTS • IPSS – international prostate symptom score • PR examination • PSA – prostate specific antigenManagement of Bladder Obstruction • Alpha Blockers • Tamsulosin • 5-alpha reductase inhibitors • Finasteride • Catheter • TURP • ProstatectomyQuestion 1 • What are the 3 layers of the detrusor muscle? • Longitudinal, circular, longitudinal • Circular, longitudinal, circular • Longitudinal, circular, oblique • Oblique, longitudinal, obliqueQuestion 1 • What are the 3 layers of the detrusor muscle? • Longitudinal, circular, longitudinal • Circular, longitudinal, circular • Longitudinal, circular, oblique • Oblique, longitudinal, obliqueQuestion 2 • What nerve stimulates the nicotinic receptor? • Hypogastric nerve • Pudendal nerve • Pelvic nerveQuestion 2 • What nerve stimulates the nicotinic receptor? • Hypogastric nerve • Pudendal nerve • Pelvic nerveQuestion 3 • What medication would be given to reduce the size of the prostate? • Alpha blocker • Beta blocker • 5-alpha reductase inhibitor • DiureticQuestion 3 • What medication would be given to reduce the size of the prostate? • Alpha blocker • Beta blocker • 5-alpha reductase inhibitor • DiureticThank you!