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Kidneys to bladder
Pacemaker in calyces Peristaltic contractions of ureters (every 10 secs) Autonomic influence of peristalsis Ureters enter bladder obliquely Vesico-ureteric reflux Ureterorenal reflex
Anatomy of bladder
Detrusor muscle Trigone Internal sphincter External sphincter Rugose mucosa Transitional epithelium Nerve supply- Nervi erigentes, Hypogastric nerve, Pudendal nerve
Cystometrogram
30-50mL: 10 cm of H20 Upto 200-300mL: minimal raise >400mL: sharp raise Laplace law
Micturition Reflex
Stretch receptors in bladder wall Afferents via nervi erigentes Sacral center Efferents via nervi erigentes Facilitation/Inhibition by higher centers
Micturition centers
Facilitatory areas: pons, posterior hypothalamus, cortical areas Inhibitory areas: midbrain, cortical areas
Voluntary micturition
Voluntary contraction of abdominal muscles Pressure on bladder increased Micturition reflex Inhibition of external sphincter
Applied aspects
1. Atonic bladder: sensory fiber destruction; tabes dorsalis; overflow incontinence 2. Automatic bladder: loss of higher control; spinal shock 3. Neurogenic bladder: partial spinal damage; loss of inhibitory fibers; meningocele
Enuresis
Treatment : (i) Urine of spaded swine (ii) Cauterization of meatus (iii) Toad tied to penis (iv) Battery and sponges Mechanisms of sphincter control: 1. Maturation & development 2. Learning 3. conditioning