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Lower Urinary Tract Appied Anatomy Lower Urinary Tract Appied Anatomy

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Lower Urinary Tract Appied Anatomy Lower Urinary Tract Appied Anatomy LowerLower UrinaryUrinary TractTract AppiedAppied AnatomyAnatomy http:// vanat.cvm.umn.edu/lutApplAnat/ T.F. Fletcher, DVM, PhD [email protected] 4-9765 Definitions: What constitutes the Lower Urinary Tract (LUT)? — what comprises the urogenital tract? ureter rectum uterus vagina neck vestibule body a urethra symphysis pelvis p e x Female Lower Urinary Tract Embryonic development of the LUT: What is the embryonic origin of the LUT? — what embryonic anomalies can you list? Embryonic development of the LUT: What is the embryonic origin of the LUT? — what embryonic anomalies can you list? ectopic ureter patent urachus (urachal fistula; vesico-urachal diverticulum) hypospadias urethrorectal fistula longitudinal muscle fascicles from ureter ureter opening urethral ductus deferens crest opening colliculus seminalis prostatic duct opening TRIGONE (internal dorsal wall of bladder neck and prostatic urethra of male dog) Hypospadias LUT functional units: What are the three functionally distinct components of the LUT? — how do functional units relate to LUT anatomy? Canine Lower Urinary Tract ureter Female smooth urethralis detrusor muscle muscle muscle sphincter ureter ductus deferens prostate urethralis muscle Male detrusor muscle smooth muscle sphincter LUT efferent & afferent peripheral innervation: In terms of the spinal origin and the major peripheral nerve, can you describe efferent innervation to each of the three LUT functional units? — how about the afferent innervation? Male Cat Lower Urinary Tract Innervation L-2 L-3 L-4 rami commuinicantes ventral branches: S-1 S-2 S-3 sympathetic trunk lumbosacral lumbar splanchnic nn. plexus caudal mesenteric ganglion pelvic nerve hypogastric pudendal nerve nerve ureter urinary bladder pelvic plexus prostate bulbourethral gland Detrusor Muscle Smooth Sphincter Striated Sphincter urethralis muscle penis pre-prostatic post-prostatic urethra urethra Spinal Cord S1 — S3 spinal nerve lumbosacral plexus ventral root pelvic nerve S2 pelvic plexus hypogastric & nerve ganglia spinal nerve ventral root ramus communicans L2 ramus communicans S2 left pelvic plexus & sympathetic ganglia trunk left caudal ganglion plexus mesenteric lumbar on splanchnic aorta ganglion nerve branches to left hypogastric nerve pelvic viscera Brain control of normal micturition: What brain components are involved in normal micturition? — what CNS circuitry is essential to completely empty the bladder? Micturition Schema Association Cerebral Cortex (cognitive interpretation of situations) Bladder Afferents Limbic System (mechanoreceptors) (emotional behavior) • awareness — mating • fullness FOREBRAIN — defending • urgency — attacking [Medial Frontal Cortex] — etc. To pee or not to pee ! That is the question. Yes Midbrain OK to pee Micturition Continence Center PONS Center Excite Detrusor & Excite Striated Inhibit Sphincters Spinal Cord Sphincter Bladder filling and compliance: What is bladder compliance and what is the histological explanation for compliance and its limitation? — how is compliance measured clinically? 20 Cystometrogram 15 10 Pressure (cm water) 5 25 50 75 100 Volume (ml) Urine storage and continence: What mechanisms are involved in maintaining urinary continence? — how are continence mechanisms related to urine volume? Continence Schema Low Passive Viscoelastic Urethral Resistance Volume Viscoelastic properties of : and — epithelium — wall connective tissue Pressure — elastic fibers — muscle fascicle arrangement — stratum spongiosum — myocyte length Sympathetic Spinal Reflexes: Volume • Tonic contraction of smooth muscle sphincter Near • Sympathetic inhibition of detrusor Half-Full (triggered by mechanoreceptors in bladder wall) Somatic Spinal Reflex: Urethralis M. Contraction Sudden Quick contraction of striated urethral sphincter Increased (triggered by urine flow into the urethra) Pressure Also, levator ani muscle contracts along with abdominal wall mm. Voluntry Contraction of Urethralis Muscle Voluntary Conscious decision by the forebrain Continence (in response to a sense of bladder fullness, or to abruptly stop urine flow when desired) Physics of elastic containers: How are wall tension, lumen volume and internal pressure related to one another for elastic spherical containers (Law of Laplace)? — what are the clinical implications for the urinary bladder? T P R P = T / R & T / R = T / R T = P R T P R Encircling > Tangential Male urogenital tract adaptations: How is the male urogenital tract designed to accommodate ejaculation? — what is the probable sequence of events during ejaculation? Postprostic Urethra Canine LowerLower UrinaryUrinary TractTract AppiedAppied AnatomyAnatomy http:// vanat.cvm.umn.edu/lutApplAnat/ T.F. Fletcher, DVM, PhD [email protected] 4-9765.
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