6th week

Fisiologi
GUS
Pandu Dian Wicaksono
Faculty of Medicine
(1510211031)
Universitas Pembangunan Nasional
Veteran
Jakarta
http://intranet.tdmu.edu.ua/data/kafedra/internal/anatomy/classes_stud/en/nurse/1/adn/ptn/1/14.%20TOP
OGRAPHY%20AND%20STRUCTURE%20OF%20URINARY%20SYSTEM%20ORGANS.files/image018.jpg
Micturition Reflex
Process by which the urinary bladder empties when it
becomes filled(Guyton, 2016)
Two main steps of micturition:
a. Tension of bladder wall micturition reflex
autonomic spinal cord reflex
b. Voluntary control cerebral cortex or brain stem
(inhibition or facilitation)
 Smooth muscle
chamber composed of
two main parts:
a. Body
b. Neck
Smooth muscle of
bladder = detrusor
muscle
Guyton, 2016
Contraction of the
muscle is a major step
in micturition
 Cystometrogra
m
Cystometrogram curves
a. Ia: first increments in volume
b. Ib: long, nearly flat segment
c. II: sudden, sharp rise
(micturition reflex triggered)
The first urge to void is felt at a 150
mL
Sense of fullness at about 400 mL

Ganong Review of Medical physiology 25th edition

 Once micturition reflex
begin, its Self-
regenerative
Micturition reflex is a
single complete cycle of:
a. Progressive and rapid
increase of pressure
b. Period of sustained
pressure
c. Return of the pressure to
Guyton, 2016
the basal tone of the
bladder
 Micturition reflex
Initiated when stretch receptors within
the bladder wall are stimulated
Parasymphatetic stimulation bladder
contraction
No special mechanism to open the
internal sphincter

Sherwood 9th edition 2016

 Voluntary Control
Voluntary control of micturition learned
during toilet training in early childhood
can override the micturition reflex
tightening the external sphincter and
pelvic diaphragm
Urination cant be delayed indefinitely
Voluntary bladder emptying may be
further assisted by contracting the
abdominal wall and respiratory
diaphragm

Sherwood 9th edition 2016

Facilitation or inhibition of micturition by the brain

The micturition is an autonomic spinal cord reflex

Micturition can be inhibited or facilitated by centers in
the brain:
a. Strong facilitative and Inhibitory centers in the brain
stem, located mainly in the pons
b. Several centers located in the cerebral cortex
Innervation
Principal nerve supply of the bladder is by way of
pelvic nerves, which connect with the spinal cord
through the sacral plexus.
Coursing through the pelvic nerves are both
sensory and motor nerve fibers (parasympathetic)
Stretch signals from posterior urethra are
especially strong and are mainly responsible for
initiating the micturition reflexes
Innervation
Skeletal motor fibers transmitted through the pudendal nerve to the
external sphincter somatic nerve (voluntary skeletal muscle)
Also, the bladder receives symphatetic innervation from the
symphatetic chain through the hypogastric nerves blood vessels

Guyton, 2016
Innervation

Ganong Review of Medical physiology 25th edition

Clinical neuroanatomu 26th edition, Lange

References
Sherwood Human Physiology, 9th Edition, 2016
Guyton and Hall Textbook of Medical Physiology 13th Edition, 2016
Ganongs Review of Medical Physiology 25th Edition, 2016
Clinical Neuroanatomy 26th Edition, Lange, 2009