PHYSIOLOGY OF

MICTURITION

Dr. Jufriady Ismy, Sp.U

NEUROANATOMY OF MICTURITION

Storage Stability and good compliance of Bladder

Empty Contraction of detrusor and opening of Urethra
Parasympathetic - Pelvic nerve
Sympathetic - Hypogastric nerve
Somatic nerves- Pudendal nerve
NEUROANATOMY OF
LOWER URINARY TRACT
NEUROANATOMY OF MICTURITION
Micturition reflex center sacral cords 2-4
Micturition control center pons
Sensory motor center frontal lobe
Limbic system
Cerebellum, Basal ganglia
SENSORY AFFERENTS

A-delta fibers Micturition reflex,

stretch and fullness sensation
C-fibers Noxious sensation,
capsaicin sensitive primary
afferents (CSPA)
Dual sensory afferents in urinary
bladder
1999. Pathophisiology and Categorization of Voiding Disfunction.
Campbells Uro
STORAGE OF URINE

Stable bladder
Good compliance
Competent urethra- mucosa, submucosa, smooth
muscles, striated skeletal muscles (external sphincter)
Good pressure transmission and hammock effect during
stress
POSITIVE PRESSURE TRANSMISSION DURING
COUGHS IN UPP TRACING
EMPTY OF URINE

Sustained detrusor contraction- cholinergic

parasympathetic fibers
Relaxation of bladder neck alpha-adrenergic
sympathetic nerves
Relaxation of external sphincter- cholinergic pudendal
nerves
Patent non-obstructive urethra
NEUROPHYSIOLOGY OF
MICTURITION REFLEXES

PONS

T10-L2

Medula Spinalis
S2,3,4
Bladder
Internal Sphingter
External Sphingter
INNERVATION OF
LOWER URINARY TRACT

Bladder- cholinergic parasympathetic- contraction; beta-

adrenergic & NO relaxation
Bladder neck alpha-adrenergic- contration
Urethral muscles- cholinergic parasympathetic, NO,
cholinergic somatic nerves
PHYSIOLOGY OF URINE STORAGE

First sensation of filling

Fullness sensation
Urge sensation
Premicturition urge sensation- phasic detrusor
contraction
Increased activity of urethral sphincter during filling
SUSTAINED DETRUSOR CONTRACTION-
URETHROVESICAL REFLEX

Stretch receptors in urethral wall

Detrusor overactivity in urgency- frequency syndrome and SUI
Role of incompetent bladder neck
Low detrusor contractility in incompetent urethral sphincter after
prostatectomy
MICTURITION DETRUSOR PRESSURE- DEPENDS ON
URETHRAL RESISTANCE

High voiding pressure indicates a greater urethral resistance

Low voiding pressure indicates a lower urethral resistance or a low
detrusor contractility
Efficient bladder empty depends on a sustained detrusor
contraction
EFFICIENT BLADDER EMPTY

Hypersensitive bladder- low detrusor contractility

Inadequate contractility in elderly
Bladder outlet obstruction- Bladder neck dysfunction, Prostatic
enlargement, Urethral stricture, Cystocele, External sphincter
dyssynergia