Guided Lecture Notes
Chapter 26: Disorders of Urine Elimination
Learning Objective 1. Trace the innervation of the bladder and control of micturition
from the detrusor muscle and external sphincter through the micturition centers in the
sacral and thoracolumbar cords, the pontine micturition center, and the cerebral cortex.

Describe the anatomy and physiology of the bladder, and describe the differences
between a full and an empty bladder (refer to Fig. 26-1).

Describe the ANS reflexes and voluntary mechanisms that control the emptying
of the bladder (refer to PowerPoint Slides 2–4, 7–8, and Figs. 26-2 and 26-3).
Learning Objective 2. Explain the mechanism of low-pressure urine storage in the
bladder.

Explain how the bladder maintains continence/retains urine via its function as a
low-pressure storage system.
Learning Objective 3. Describe various studies that can be used to assess bladder
function.

Discuss the usefulness of PVR, pelvic exams, urine tests, and visualization of
bladder structures (x-rays, CT scans, MRIs) in the evaluation of bladder function.
Learning Objective 4. Discuss the bladder capacity of children as it relates to their age
in years.

Discuss continence in children, and identify factors that affect conscious control
of bladder function.
Learning Objective 5. Describe the causes of and compensatory changes that occur
with urinary tract obstruction.

Identify common causes and categorizations of urinary tract obstruction (refer to
Chart 26-1).

Describe the pathology, clinical manifestations, and treatment of urinary tract
obstruction (refer to PowerPoint Slide 16 and Fig. 26-4).
Learning Objective 6. Differentiate lesions that produce storage dysfunction associated
with spastic bladder from those that produce emptying dysfunction associated with
flaccid bladder in terms of the level of the lesions and their effects on bladder function.

Compare spastic and flaccid bladder disorders with regard to level of lesions,
causes, changes in bladder function, and treatment.
Learning Objective 7. Cite the pathology and causes of nonrelaxing external sphincter.

Describe the etiology, pathology, clinical manifestations, and treatment of
nonrelaxing external sphincter.
Learning Objective 8. Describe methods used in the treatment of neurogenic bladder.

Compare spastic and flaccid bladder disorders with regard to treatment options.
Learning Objective 9. Define incontinence and list the categories of this condition.

Define urinary incontinence and discuss its incidence (refer to Fig. 26-5).

Compare types of urinary incontinence (stress, urge, overflow), citing the
characteristics of each (refer to Table 26-2).
Learning Objective 10. List the treatable causes of incontinence in the elderly.

Discuss the incidence of incontinence in the elderly population, and identify the
causes of incontinence that can be treated.
Learning Objective 11. Describe behavioral, pharmacologic, and surgical methods used
in the treatment of incontinence.

Discuss diagnostic and treatment modalities for urinary incontinence.
Learning Objective 12. State the most common sign of bladder cancer.

Discuss the incidence of bladder cancer, and identify associated risk factors.

Describe the clinical manifestations of bladder cancer.
Learning Objective 13. Discuss the treatment of bladder cancer and how it relates to the
extent of the lesion.

Describe diagnosis and treatment options for bladder cancer.

Explain how the patient’s health and the extent of the lesion determine treatment.