The puerperium
Louise C Kenny, Jenny E Myers in Obstetrics, 2017
Voiding difficulty and overdistension of the bladder are not uncommon after childbirth, especially if regional anaesthesia (epidural/spinal) has been used. It is now known that after epidural anaesthesia the bladder may take up to 8 hours to regain normal sensation. During this time, about 1 litre of urine may be produced. Therefore, if urinary retention occurs, considerable damage may be inflicted on the detrusor muscle. Overstretching of the detrusor muscle can dampen bladder sensation and make the bladder hypocontractile, particularly with fibrous replacement of smooth muscle. In this situation, overflow incontinence of small amounts of urine may erroneously be assumed to be normal voiding. Fluid loading prior to epidural analgesia, the antidiuretic effect of high concentrations of oxytocin during labour, increased postpartum diuresis (particularly in the presence of peripheral oedema) and increased fluid intake by breastfeeding mothers all contribute to the increased urine production in the puerperium. Therefore, an intake/output chart alone may not detect incomplete emptying of the bladder.
Systemic and intrathecal pharmacologic treatment
Jacques Corcos, David Ginsberg, Gilles Karsenty in Textbook of the Neurogenic Bladder, 2015
The traditional view is that urologic agents block anticholinergic stimulation of the detrusor muscle and consequently decrease the bladder’s ability to contract. However, the main effects of urologics are decreased urgency and increased bladder capacity. Such observations imply that these agents act mainly during the filling phase, although there is supposed to be no parasympathetic input to the bladder during this phase.9 Some experimental evidence indicates that, during the filling phase, acetylcholine may be released from both neuronal and nonneuronal sources, and directly or indirectly excites afferent nerves in the suburothelium and within the detrusor. Another proposed mechanism of action includes blockade of afferent nerves from the bladder (both C- and Aδ-fibers).10
Gastrointestinal and genitourinary systems
Helen Butler, Neel Sharma, Tiago Villanueva in Student Success in Anatomy - SBAs and EMQs, 2022
35 Which of the following statements regarding the control of micturition is correct? The external urethral sphincter is a smooth muscle under sympathetic control.S2–S4 parasympathetic innervation results in contraction of the bladder.Sympathetic supply of the detrusor muscle stimulates micturition.The external urethral orifice lies posterior to the vaginal opening.Both internal and external sphincters are under voluntary control.
Induction of bacterial cystitis in female rabbits by uropathogenic Escherichia coli and the differences between the bladder dome and trigone
Published in Ultrastructural Pathology, 2021
Manal A. Othman, Hicham M. Ezzat, Diaa E.E. Rizk, Amer H. Kamal, Ali E. Al-Mahameed, Ammar M. Marwani, Khalid M. Bindyna, Stefano Salvatore
Despite the physiological and anatomical importance of the trigone of the urinary bladder, there is very scarce literature about its histological structure.15,16 Functional differences between the bladder dome, and trigone is currently receiving more attention in the pathogenesis of the overactive bladder syndrome.17,18 The trigonal detrusor muscle has more spontaneous activity than that of the dome and is thought to initiate contractions of the whole urinary bladder. Furthermore, several studies have suggested that infections located within the trigone may be associated with a higher risk of recurrence than those affecting the rest of the urinary bladder.19 Histological differences between the trigone and the dome may be responsible as the former has smaller muscle cells and distinct gap junction proteins that are likely to be responsible for recurrence of infection.20
Current status of the development of intravesical drug delivery systems for the treatment of bladder cancer
Published in Expert Opinion on Drug Delivery, 2020
Ho Yub Yoon, Hee Mang Yang, Chang Hyun Kim, Yoon Tae Goo, Myung Joo Kang, Sangkil Lee, Young Wook Choi
The urinary bladder is a spherically shaped hollow organ; its basic function is the short-term storage of urine. The volume of urine in the bladder is affected by several factors such as gender, ethnicity, and race; however, the average volume is approximately 400–600 mL [22]. However, the presence of approximately 150 to 200 mL of urine in the bladder triggers the first sensation of urination, which is regulated by the myovesical plexus within the bladder that sends the voiding signal to the detrusor muscle, which regulates the extent and frequency of voiding [21]. Although IDD offers the advantage of delivering a large amount of instilled drug at the tumor site in the bladder without an increase in systemic blood levels, the bladder is constantly filled with urine, which eventually dilutes the drug. As illustrated in Figure 1, the periodic voiding of urine washes out the instilled drugs, resulting in a reduced duration of action and, consequently, the need for frequent dosing.
Long-term urodynamic findings following radical prostatectomy and salvage radiotherapy
Published in Scandinavian Journal of Urology, 2018
Maria Ervandian, Jens Christian Djurhuus, Morten Høyer, Charlotte Graugaard-Jensen, Michael Borre
A study investigating bladder outlet obstruction after PCa treatment found that 12.6% of the patients underwent at least one surgical procedure for bladder outlet obstruction [25]. These results are comparable with the rate of patients presenting urethral strictures (12.5%) in the present study. The relatively low rate of patients with urethral stricture invites the hypothesis that the principal factor related to bladder outlet obstruction is decreased bladder compliance, which potentially is a result of radiation-induced fibrosis. This is supported by Oh et al., who found that ART after radical hysterectomy for uterine cervical cancer had a significantly negative effect on bladder compliance [26]. A review of voiding dysfunction after RP found that 8–39% of the patients had a non-compliant bladder, which may be due to partial detrusor muscle denervation after surgery [21]. The results indicate that patients treated with both RP and SRT are at high risk of developing reduced bladder compliance. A long follow-up period is relevant when evaluating the effect of radiation-induced fibrosis on bladder function [27]. In the present study, the follow-up period is 7.7 years, which is one of the longest in urodynamic studies.
Related Knowledge Centers
- Bladder
- Muscular Layer
- Smooth Muscle
- Urination
- Urine
- Urethra
- Vagina
- Prostate
- Urethral Sphincters
- Pubis