Chapters Index (French) French Version Welcome page Contact

Urinary disorders are very frequent during palliative care. They may be related to the patient's progressively altered general state and to certain necessary drugs. They may also be related to genital or urinary cancer.

Physiology of micturition

Notre vessie comporte deux sphincters : Our bladder has two sphincters:

internal sphincter, intimely related to bladder muscles (detrusor), with an innervation which is:

sympathetic (through hypogastric and lumbar nerves, and whose neurotransmitter is adrenalin),

parasympathetic (through pelvis nerves originating from S2-S3).

Bladder distension stimulates mechanical receptors inside the bladder wall and provokes a motor parasympathetic response with the contraction of bladder muscles and the opening of the internal sphincter.

external sphincter

constituted by striated muscle fibres originating from pelvic floor (distal region of prostate in men and median third of urethra in women).

The external sphincter is controlled of nerves originating from the sacrum (pudental nerve).

For a normal micturition, three elements are necessary:

a free passage from the bladder to the urethral meatus,

tonic bladder wall muscles (muscle contraction for micturition),

a good neurological coordination.

Main questions treated in this chapter:

Incontinence,

Acute urine retention,

Ureteral bilateral compression and urinary stoppage,

Ureteral unilateral compression,

Urinary fistula.