Abstract
Came to the emergency department.He was conscious and oriented, but had severe lower back pain.Power 1/5 in both lower limbs.DTRs were lost; bilateral extensor plantar responses.Numbness in both lower limbs; touch, temperature, pain and dorsal column sensation lost in both lower limbs.No cranial nerve palsies were noted.Magnetic resonance imaging (MRI) of the spine showed an extensive hematoma in the lumbosacral area compressing several lumbosacral nerves in the cauda equina, along with fractures at the L1 and L2 vertebrae causing compression at the conus area. Questions• Briefly describe the anatomy of the urinary bladder.• Physiology of micturition and neural control.• Bladder dysfunction in neurology.• What is incontinence?• Management. AnAtomy o f t h e BlAdderThe urinary bladder is a hollow viscus that acts as a storage organ for urine.In adults, it is a pelvic organ.The average capacity of the bladder is approximately 220 mL.The sense of filling comes when storage is 100-150 mL.Desire for micturition starts when it crosses 150 mL.On collection above 800 mL, voluntary control is lost, and overflow incontinence happens. 1 Wall of bladder presents from outside to inside following coats: serous, muscular, submucosa, mucous.Muscular layer called detrusor muscle.Detrusor has three layers of muscle.The outer layer is continuous with the prostate.Middle circular layer encircles the bladder and thickens around the internal urethral orifice to form the involuntary sphincter.The inner longitudinal layer is continuous with the muscle of the urethra.The external sphincter is voluntary muscle, derived from sphincter urethrae and surrounds membranous urethrae. nerve supplyThe bladder is supplied by both the sympathetic and parasympathetic autonomic nervous system.Both have motor and sensory fibers. cAse2A 45-year-old male suffered from a road traffic accident.He developed weakness of both Lower limbs with urinary retention.
