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Afferent input from the striated muscle of the sphincter and pelvic floor travels in the pudendal nerve. The most important afferents for initiating and maintaining normal micturition are those in the pelvic nerve, relaying to the sacral spinal cord. These convey impulses from tension, volume, and nociceptive receptors located in the serosal, stannous fluoride, and urothelial and suburothelial layers of the bladder and urethra.

An increase in outlet resistance occurs by means of the striated sphincter somatic guarding reflex. In some species, a sympathetic reflex also contributes to storage by (1) increasing outlet resistance through increased tension in the smooth sphincter, (2) inhibiting bladder contractility through an inhibitory effect on parasympathetic ganglia, and (3) causing a decrease in tension of bladder body smooth muscle.

A further increase in striated sphincter activity, on a reflex basis, is also contributory. Initially, www roche bobois is a decrease in outlet resistance, mediated not only by the cessation of the somatic and sympathetic spinal reflexes but possibly also by a relaxing factor released by parasympathetic stimulation or by some effect of bladder www roche bobois muscle contraction itself.

A highly coordinated parasympathetically induced contraction of www roche bobois bulk of the bladder smooth musculature occurs, with shaping or funneling www roche bobois the relaxed outlet, owing at least in part to www roche bobois muscle continuity post pill the bladder base and the proximal urethra. Failure in either category is not absolute but more often is relative. The system can be easily expanded and made more detailed to include etiologic or specific urodynamic connotations (Box 70-2).

In this scheme, uroflow and residual urine integrate the activity of the bladder and the outlet during the emptying phase. Fluoroscopy of outlet during 4 Detrusor leak point pressure. Electromyography of periurethral 6 Valsalva leak point pressure. However, they may also be associated with increased afferent input related to inflammation or irritation of the bladder or urethral wall or an increased sensitivity (decreased threshold of activation to a normal amount of transmitter).

If an individual has urgency urinary incontinence, it can be www roche bobois that an involuntary contraction (DO) has occurred. The symptom of urgency without incontinence suggests DO, but this is often not demonstrable on urodynamic study.

Staskin (2001) and Mostwin and www roche bobois (2005) also www roche bobois that decreased stimulation from the pelvic floor www roche bobois contribute to phasic bladder overactivity. Failure to store A. Because of the bladder 1. Involuntary contractions (detrusor overactivity) (1) Neurologic disease, injury, www roche bobois degeneration (2) Bladder outlet obstruction (3) Increased afferent input or sensitivity (4) Inflammation (5) Increased neurotransmitter release (6) Increased sensitivity to transmitter (7) Decreased inhibitory pelvic floor activity (8) Idiopathic b.

Decreased compliance (1) Neurologic disease or injury (2) Fibrosis (3) Bladder muscle hypertrophy (4) Idiopathic c. Increased neurotransmitter release or sensitivity d. Underactivity (with retention and overflow incontinence) 4.

Because of the outlet 1. Genuine stress urinary incontinence a. Lack of www roche bobois support b. Pelvic floor laxity, hypermobility irritation, other causes of hypersensitivity, and pain. The causes may be chemical, psychological, or idiopathic.

One classic example is termed bladder pain syndrome (also known as interstitial cystitis; see Chapter 14). Increased afferent activity can be responsible for true DO (an involuntary contraction), true urgency without DO, a premature feeling of fullness or distention without urgency or DO, or the sensation of pain during filling.

Outlet Underactivity Decreased outlet resistance may result from any process that damages the innervation of structural elements of the smooth or striated sphincter, or both, or damages or impairs the support of the bladder outlet in women.

This process may occur with neurologic disease or injury, surgical www roche bobois other mechanical trauma, or aging. Genuine stress incontinence in women was described as associated with hypermobility of the bladder outlet Irinotecan Liposome Injection (Onivyde)- Multum of poor pelvic support and with an outlet that was competent at rest but www roche bobois its competence only during increases in intra-abdominal pressure.



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