URINARY BLADDER Imaging

4. IMAGING

4.1 Cystography is a radiologic outlining of the bladder by injection of radioopaque dye into the bladder besides identifying lesions from the bladder mucosa, voiding studies give information on the function of bladder neck sphnicter. Information on reflux into the ureter can also be obtained.

4.2 Ultrasonography with a rectal probe can provide information on the size of the prostate and volume of residual urine in the bladder

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URINARY BLADDER 3 visualisation

3. CYSTOURETHROSCOPY

Can provide direct visualisation of the bladder trigone ureteric orifices and urethra. This investigation also provides opportunity for obtaining histopathological material for biopsy.

CYSTOSCOPY

OBJECTIVE

In cases of:

-        Haematuria and urinary infection

-         interior of the urethra, the bladder and the ureteral orifices are viewed

STEPS

-        Urethra may be dilated initially with a sound

-        Lubricated cystoscope is inserted in the urethra

-        Urethra is inspected as the cystoscope is advanced into the bladder

-        The obturator is removed

-        Bladder is filled with irrigation fluid, and under direct visualization the bladder, ureteral orifices, bladder neck, and urethra are examined

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URINARY BLADDER 2

1.2 Micturition

      The patient feels fullness and wishes to void. If it is convenient to void, the patient holds his breath, contract the abdominal muscles, detrussor also contracts, there will be increase in intravesical pressure, overcomes falling urethral resistance; voiding begins and the bladder empties. If not convenient the detrussor relaes to accomodate the urine.

(Fig 26.2)

2. URODYNAMICS

      These studies are utilized for assessment of the lower urinary tracts (bladder, urethra) in chronic retention and incontinance cases. These studies provide information on :

2.1 Cystometery : Volume and pressure change in the bladder.

2.2 Urine flow studies : Volume of urine voided in cc per second of time. A urinary flow rate of 25 ml is considered normal. The other parameters are voiding time, peak flow rate 

2.3 Measuring urine loss in incontinence.

      There are other more complex studies that measure flow with pressure changes. These can be combined with imaging of bladder or Electromyograph of pelvic floor.

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Urinary Bladder & Prostate 1

BLADDER AND PROSTATE

1. FUNCTION OF URINARY BLADDER

      The primary function of the bladder is to store urine until voiding is required by the patient. The bladder receives innervation from both sympathetic and parasympathetic autonomic nerves.

1.1 Nerves Supply

      The sympathetic preganglionic nuclei are in the first and second lumbar segments and possibly twelfth thoracic spinal cord segment. Fibers proceed down the aorta to the iliac vessals and then follow the ureters before fanning out to enter the bladder (fig 26.1).

      Parasympathetic preganglionic cell nuclei are in the second, third and fourth sacral segments of the spinal cord and travel with pelvic splanchnic nerves to enter the bladder. Afferent sensory fibres from the bladder can exit along either sympathetic or parasympathetic pathways. The normal bladder will fill to a volume of 400 ml. with no increase in pressure since the detrussor muscle will relax to accommodate this volume.

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