Uro-Neurology
A. Bladder detrusor and internal sphincter
1. Parasympathetic: Acetylcholine from S2-4 via pelvic nerve constricts bladder via muscarinic receptors.
2. Sympathetic: Norepinephrine from L2-4 via hypogastric nerve constricts sphincter via α-receptors. The bladder has β-receptors.
B. External sphincter
Voluntary control via S2-4
C. H&P
Often a poor correlation between sx and urodynamic findings.
1. Autonomic dysreflexia: Urgent problem. In pts with spine injury (usually above T5/6). Pain, bladder distension or catheterization, bowel distension, or other stimuli can trigger acute hypertension, bradycardia, anxiety, and headache. Sit the pt. up, and treat BP promptly, e.g., with nifedipine 10 mg SL.
2. Frequency or urgency: From high fluid intake, urinary tract infection, partial outlet obstruction (prostate, diaphragm), upper or lower motor neuron lesion, psychosomatic.
3. Urinary retentionRelated posts:
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