Slide 1

BLADDER:ANATOMY AND PHYSIOLOGYMCQs

During the normal filling phase of the bladder(a) The detrusor pressure rises only minimally(b) Proprioceptive impulses pass via the pudendal nerves(c) The first desire to void occurs at about 100 ml capacity(d) There may be voluntary pelvic floor contractions to maintain continence(e) An abnormally high detrusor pressure may be caused by interstitial cystitisT;F;F;T;T;

The pelvic floor(a) has two distinct layers of support(b) is commonly disrupted by childbirth(c) gains the majority of its support from the transverse perineal muscles(d) consists of both fascial and muscular supporting structures(e) receives nerve supply from both the pudendal nerve and the pelvic plexus

F; T; F; T; T;

The pelvic oor has three distinct layers of support, the endopelvic fascia, the levatorani muscles and the perineal membrane. The transverse perineal muscles have littlefunction in supporting the pelvic oor and all of the musculature and fascia can bedisrupted by childbirth. Innervation comes from two embryological components withthe pelvic oor muscles receiving innervation from the pudendal nerves and pelvi-caudal component receiving innervation from the motor branches of the pelvic plexus.3

Of the drugs used in the treatment of bladder symptoms(a) Oxybutinin acts by an antimuscarinic action and a direct relaxant effect on the smooth muscle(b) Oxybutinin may have a dilitarious effect on cognitive function in the elderly(c) Tolterodine is more effective than Oxybutinin in controlling frequency of micturition(d) Imipramine is effective in the treatment of nocturnal enuresis in children(e) Desmopressin (DDAVP) can be used for treating nocturnal frequency and enuresis in adultsT; T; F; T; T;

Tolterodine has a primarily antimuscarinic (anti-cholinergic) action while Oxybutinin has a combined effect, with an action directly on smooth muscle. Impramine decreases the delta wave of sleep where enuresis occurs.Among the side- effects of Oxybutinin, negative effects on cognitive function in the elderly have beenreported, including hallucinations, agitations and confusion. However, antimuscarinicside-effects (dry mouth, constipation, drowsiness, blurred vision) are more common.Tolterodine appears to be similarly effective to Oxybutinin in controlling frequencyand urgency but is reported to have less anti-cholinergic side-effects. Desmopressin can be used in both adults and children although the effects are less predictable inadults.4

Oral anti-cholinergic treatment used currently(a) is highly selective for bladder smooth muscle(b) increases bladder capacity(c) includes the drug baclofen(d) reduces leakage due to genuine stress incontinence(e) should not be used in patients with glaucoma

F; T; F; F; T;

Currently used anti-cholinergic treatments are not highly selective for bladder smoothmuscle and can have systemic side-eects such as a dry mouth and constipation. Theyshould not be used in patients with glaucoma. Anticholinergic drugs include Pro-pantheline, Emepronium, Tolterodine and Oxybutinin. Bladder capacity is increasedand urgency symptoms reduced. Anticholinergic drugs do not reduce leakage due togenuine stress incontinence but may do so with leakage due to detrusor instability.5

With regards to the somatic storage reflexIts mediated in the Pontine micturition center.Higher centers have no role.NA and serotonin are inhibitory in the Onufs nucleus.Aids in stress continence mechanisms.Duloxetine acts as a adrenergic receptor agonist.F; F; F; T; F;