May 11 Lecture

Shah

High compliance of bladder important in preventing post renal renal failure (high pressure in Bowman's capsule).

Micturition:  ANS modulates reflexes involved in micturition.  PNS facilitate voiding.  SNS facilitate storage. Somatics contract sphincter and can stop voiding.  Pontine micturition center is mainly inhibitory.  spinal cord damage = overactivity & incontinence.

Incontinence:  

1. Urge (failure to store)
2. Stress (failure to store; intrinsic sphincter deficiency; relaxation of pelvic floor muscles)
3. Overflow (failure to empty; BPH-urethral obstruction) 

Treatment of voiding disorders

• behavioral - 
• pharmacological 
• muscarinic antagonists - slow the bladder treats urge incontinence
• alpha blockers - inhibit prostate smooth muscle. treat BPH
• surgical - improve pelvic support structures; artificial sphincter

Ureters have pacemaker, propagation of urine to bladder

Kidney stones - phases of obstruction

1. increased ureteral pressure - increased renal blood flow
2. increased ureteral pressure - decreased renal blood flow
3. decreased ureteral pressure - decreased renal blood flow  (ischemia; renal damage)

risk factors
dehydration
high salt intake - increases calcium secretion (hypercalciuria)
acid urine - precipitates uric acid stones


kinds of stones

1. calcium oxalate - most common
2. uric acid
3. Struvite (Mg and ammonium phosphate) in recurrent UTI with urease splitting bacteria
4. Cysteine - autosomal recessive stone disease

Treatment

• alkalinize urine - uric acid stones
• hydration
• alpha blockers (expel stones)
• surgery