ee

EE

ee

b
S2, S3, S4 level
this is neurogenic bladder, right?

The correct answer is Choice E . The thoracic spinal cord.

The inhibitory fibres to the bladder descend from the cortex and mainly leave in the nerve roots T-12 to L

2. Damage to these fibres will cause detrussor instability.

Damage to the sacral roots will cause overflow in-continence.

it',s a usmle world question

sammy10 or anyone, please explain this further.

my concept on the micturition topic is not clear.

it',s EE but can u explain how descending from cortex leaving at T12 to L2 Please .thanx

sympathetic = thoracolumbar = T1 - L3
only through these spinal cord segments arise sympathetic nerves..which relax bladder wall and constrict sphincter..

all other given answer options belong to parasympathetic nervous system..which constrict bladder wall and relax sphincter..

so damage to sympathetic innervation of bladder leads to unopposed parasympathetic dominance, therefore bladder constrict with minimal stretching in this case..

as i understand it

in urge incontinence the lesion is similar as in this case..the lesion somewhere in sympathetic system (brain, spinal cord or peripheri)..

in neurogenic bladder lesion of parasympathetic Answer leads to increased sympathetic tone and sphincter overactivity which causes difficulty or full inability to pass urine without use of a catheter

You are welcome!

hello goforward how r Choice u ..

so say like if there is a Complete bilateral lesion at upper thoracic level what happen to bladder since both sympathetic(thoracolumber) and parasympathetic(S2S3S4) outflow to bladder and sphincters are below to the lesion.

hello sarim,
thank you i am fine.

how are you?

sorry for delayed answer.

i was offline.

in paraplegic patients urinary incontinence is most prevalent.. they often need permanent urinaty catheterization.
so in my opinion these patients lose both sympathetic and parasympathetic outflow to bladder and sphincter..i think in normal person these two autonomic neurvous systems are not equally control the baldder.. sympathetic control predominate.. so if patient lose both system.. he loses more sympathetic.. so therefore these patients present with urinary incontinence, not by urinary retention..
it is my understanding of this question.. maybe i am wrong..