1. Essentials of Pathophysiology
Chapter 27 Disorders of the Bladder and Lower Urinary Tract

2. Pre lecture quiz true/false
The storage and emptying of urine involves voluntary (somatic nervous system) control only.
Stress incontinence is the involuntary loss of urine during coughing, laughing, sneezing, or lifting, which increase intra-abdominal pressure.
The average bladder capacity (in ounces) is equal to the age (in years) + 2 of the child.
Urinary incontinence is not a common problem in elderly persons.
Flaccid bladder dysfunction is a neurogenic disorder of the bladder in which bladder emptying is impaired.
In flaccid (hypotonic) neurogenic bladder, volume is large, pressure is low, and contractions are absent. It may result from peripheral nerve damage or spinal cord damage at the S2 to S4 level (Overflow incontinence)

3. Pre lecture quiz
A neurogenic disorder of bladder function, which is manifested as a failure to store urine, is known as __________ bladder dysfunction.
The most common sign of bladder cancer is painless __________.
__________ incontinence is characterized by the involuntary loss of urine that results from overfilling of the bladder.
The _______________ nervous system promotes bladder emptying.
In men, the most important cause of urinary obstruction is external compression of the urethra caused by enlargement of the __________ gland.
hematuria
Overflow
parasympathetic
prostate
spastic

4. Micturition Reflex urine produced in kidneys ureters bladder fills
Begins when bladder contains mL of urine
urine
produced in
kidneys
ureters
bladder fills
with urine

5. Stretch Receptors in the Bladder
micturition
center in
stretch
bladder fills
stretch
spinal reflex
pons
receptors
with urine
receptors
stimulated
stimulated

6. Urination Detrusor muscle of bladder contracts to push urine out
Abdominal muscles may also be used
Internal sphincter relaxes
External sphincter relaxes
Unconscious in young children
Under conscious control in adults

7. Question
Tell whether the following statement is true or false: Abdominal muscles are used during forced urination.

8. Controlling Nerves Parasympathetic- contracts detrusor and inhibits
sphincter
Sympathetic- inhibits detrusor and contracts sphincter
Author: Please add title.

9. Answer
True Passive urination occurs when the bladder’s detrusor muscle contracts, and both internal and external sphincter muscles are relaxed. Abdominal muscles contract in order to force the excretion of urine.

10. Parasympathetic Nerves
bladder fills
stretch
spinal reflex
with urine
receptors
stimulated
detrusor
parasympathetic
muscle
M3 receptors
neurons
contracts
M3 receptors
internal sphincter
relaxes and is pulled
open

11. Micturition Center Allows Conscious Control
center in
stretch
bladder fills
pons
receptors
with urine
stimulated
detrusor
muscle
contracts
Conscious Control
external
internal sphincter
sphincter
relaxes and is pulled
relaxes
open

12. Question
All but which of the following stimulates urination?
Parasympathetic nervous system neurons
Micturition center
Sympathetic nervous system
Spinal reflex

13. Answer
Sympathetic nervous system
The micturition center in the pons and the spinal reflex respond to stretch receptors in the bladder to stimulate urination. The parasympathetic nervous system neurons are stimulated by the spinal reflex to cause urination. Sympathetic NS (fight-or-flight) decreases activity in both the excretory and digestive systems.

14. Scenario
A 63-year-old woman complains of stress incontinence, and her 60-year-old husband complains of difficulty voiding.
Question:
Why do people of the same age and lifestyle have opposite problems with urination?

15. Male vs Female Urethra Female is urethra 2.5–3.5 cm long
Allows urine to pass more freely
Male urethra 16.5–18.5 cm long
Passes through prostate

16. Question
Tell whether the following statement is true or false. Benign prostatic hyperplasia (BPH) has no effect on the elimination of urine.

17. Answer
False Because the male urethra passes through the prostate gland, if the gland increases in size, the urethra may become compressed or obstructed. This decreases the diameter of the urethra’s lumen, and the ability to urinate is diminished.

18. Scenario
Six months later, the husband develops urgency and incontinence.
The doctor explains that it's due to his muscle strength.
Question
Which muscles is the doctor talking about?
How did they cause incontinence?

19. Bladder Wall Hypertrophy
The bladder may also pouch outward in diverticuli