Voiding Dysfunction

Voiding Dysfunction - Voiding Dysfunction in Children COL...

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Unformatted text preview: Voiding Dysfunction in Children COL John Roscelli Pediatric Nephrology San Antonio Military Pediatric Center Perspective Incontinence is part of transitional phase from infantile to adult lower urinary tract function Wetting disorders often considered necessary nuisance & tolerated until child lags behind peers Parental concerns about voiding are common & often supersede the child's anxiety However, voiding dysfunction can be a sign of underlying pathophysiology that needs Rx to prevent Renal/Urologic damage Agenda How the Lower Urinary Tract Works Voiding Dysfunction in children with no organic pathology Definition Presentation modes Evaluation Treatment How the Lower Urinary Tract Works Bowl and Bladder Function Lower GU tract tied to lower GI tract Same embryogenic origin: endodermal tissue Up to sixth week gestation urogenital sinus & the hindgut empty into common cloaca Problems with elimination in one usually associated with problems in the other Proper term is Elimination Dysfunction Syndrome Function of Lower Urinary Tract STORAGE of adequate volumes of urine at low pressure & with no leakage EMPTYING that is Voluntary Efficient Complete Low pressure Lower Urinary Tract is a Functionally Integrated Unit Ureteral Vesicle Junction Bladder Sphincter Urethra Neurologic control mechanisms Anatomy & Neurophysiology of the Lower Urinary Tract Bladder (detrusor) Stores urine at low pressure Compresses urine for voiding Urethra Conveys urine from bladder to outside world Sphincter(s) internal & external Controls urine flow & maintain continence between voidings Nervous system control of Lower Tract CNS Periaqueductal gray matter receives bladder filling info Frontal/parietal lobes & cingulate gyrus inibit lower micturation centers Hypothalamus center initiate voluntary voiding Pontine Micturation center excites Bladder & inhibits sphincter Cerebellum integrates Spinal Sympathetics T10-L1 via hypogastric Nerve S2-S4 Parasympathetic via Pelvic N Somatic via Pudental N Nervous system control of Lower Tract CNS micturition centers Exert voluntary control over spinal centers Spinal micturition centers T10-L1 Sympathetics via hypogastric Nerve S2-S4 Parasympathetic via Pelvic N Somatic via Pudental N CNS micturition centers T10- L1 S2- S4 Autonomic NS receptor Distribution Low pressure storage with continence Outlet obstruction: Sympathetic -adrenergic stimulation of bladder neck & posterior urethra from T10-L1 via Hypogastric Nerve Somatic stimulation of External Sphincter from S2-S4 via Pudental Nerve Bladder Relaxation: -adrenergic stimulation of bladder fundus from T10-L2 via Hypogastric Nerve decreases bladder tone Allows continent storage of significant volumes of urine at < 20 mmHg CNS micturition centers T10-L1 S2- S4 Voluntary Efficient Complete Low Pressure Voiding...
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This note was uploaded on 02/01/2012 for the course PDBIO 305 taught by Professor Woods,a during the Fall '08 term at BYU.

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Voiding Dysfunction - Voiding Dysfunction in Children COL...

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