Dr Alexander M.

Tungu (MD, PhD)

Lecturer and Post Doc Fellow
Department of Physiology
 Physiologic Anatomy of the Urinary Tract
Upper Urinary Tract
Lower Urinary Tract

 Normal Physiology of Micturition

Urinary Bladder filling
Urinary Bladder emptying

 Pathophysiolgy of Urinary Bladder Dysfunction

 Kidneys filter the blood to
generate urine continuously

 Urine passes through the ureters

to the bladder (peristalsis)

 Bladder stores urine (~500mL)

 Bladder empties urine

periodically (“urination” or
“micturition”)
 A local spinal cord reflex action
Initiated when volume=400mL

 Bladder filling:
Under sympathetic nervous system (SNS) control
SNS causes relaxation of the detrussor muscles & contraction of internal
sphincter

 Bladder emptying:
Under parasympathetic nervous (PSNS) control
PSNS causes internal sphincter relaxation & detrussor muscle contraction
 Theexternal syphincter is under voluntary control via
pudendal nerve:
Allows decisions to be made on whether to void or not

 Note: The brain can also control the spinal micturition reflex
 Absence of bladder contraction
(atonic bladder)

 Due to pelvic nerve damage

resulting in either lack of
sensation or lack of
parasympathetic motor control.
eg; diabetes melitus, tabes
dorsalis, crush injury to the lower
spine.

 Can result in "overflow

incontinence"
 Mostly due to anatomic causes
(anatomic obstruction)

Eg. Benign Prostatic Hyperplasia

(BPH)
 Unable to allow complete filling

 Due to - Infection (eg; UTI)

 Neurologic:
Brain- stroke
Suprasacral spinal cord damage

 Neurologic dysfunction leads to:

Impaired sympathetic inhibition, resulting in "automatic bladder"
 Reduced resistance may be:

Structural (eg; weakness of pelvic

floor muscles)

Neurologic (eg; damage to pudendal

nerve).
 Bladder filling is
under sympathetic control and emptying
under parasympathetic control

 Pontine micturition center achieves voluntary control of

urination via its control of the spinal micturition reflex and the
external sphincter.

 Problems of urine control can have local (structural, infective

causes) or neurologic causes (brain, spinal cord).