Renal | Micturition Reflex

Official Ninja Nerd Website: ninjanerd.org
Ninja Nerds!
In this lecture Professor Zach Murphy will be presenting on the micturition reflex. We talk about how the sympathetic and parasympathetic systems influence micturition, in addition to the skeletal and smooth muscles that are responsible for maintaining continence. We hope you enjoy this lecture and be sure to support us below!
References:
● Moore, K. (2018). Clinically Oriented Anatomy, 8th ed. Philadelphia: Wolters-Kluwer.
● Sam, P., Jiang, J., & LaGrange, C. (2020). Anatomy, Abdomen and Pelvis, Sphincter Urethrae. In S. [Internet], StatPears [Internet]. Treasure Island: StatPearls Publishing.
● Hall, J. (2016). Guyton and Hall Textbook of Medical Physiology. Philadelphia: Elsevier.
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#ninjanerd #MicturitionReflex #Renal

[@mondirahpanda6520]

Thanks. Now I understand what Guyton is saying. Loool

[@NoorKhan-pv3ex]

me also

[@amatullahhafija483]

Same here.🤣🤣

[@FarhanKhan-kx4yh]

Lol so true

[@НодирАкбаров-й9н]

Oooh , Guyton is pidaraz

[@obedbagona7402]

Same! - Philippine medical student

[@M7mdx3zz]

When I become a resident, I’m gonna give you a FAT donation, because you deserve it, thanks for helping me

[@andresbeltre7378]

hahah i was thinking the same thing!

[@wiseturtule]

Haha, I misread it as: "When I become president"

[@hoseinjalalvand2055]

i’m hossein the reminder

[@rayzins6373]

Same here. He deserves a whole chunk of the bag because he's literally medschool personified

[@aslbekyuldoshev5264]

Me too

[@jameelsuhotoo1700]

The micturition reflex. The bladder is a muscular layer- the red coloring is the smooth muscle layer and is actually called the detrusor muscle. It is the thick muscularis layer of the bladder. The little mucle right below the bladder is called the internal urethral sphincter. The ones closer to the deep transverse perineus muscle is the external urethral sphincter. it is a component of the urogenital diaphragm. lets say the bladder is empty. There is just little urine in the bladder( about 10 to 20 ml of urine after urinating), this is going to be an empty bladder. what actually controls our bladder ? It is the reflexes and our CNS. the stretch receptors are located within the detrusor mucle layer and they respond to stretch. little urine in the bladder means less action potential to the spinal cord. sacrospinal cord( S2 S3 S4). The thoracolumbar part of the spinal cord ( T11 to L2).Another part of the brainstem is the pons( there are 2 centres in the pons- one is the pontine storage center and the other is the pontine micturition center). the last one is going to be the higher braincentres ans in this case this is going to be the cerebral cortex. - making you conscious. the stretching is going to be minimal stretching so little action potential in the sensory afferent neurone, so this is going to send very slow and very few action potential down the sensory neurone. 2 things will happen. neurones are stimulated that take the sensory fibres upwards to the thoracolumbar region of the spinal cord . these synapses with pregagnlionic motor neurones located within the lateral grey horn of the spinal cord . out of the lateral grey horn, they are going to synapse on the actual cell bodies of the post ganglionic motor neurones located within a ganglia ( the inferior mesenteric ganglion). it synapses on the neurones that go out to 2 destinations. one is the detrusor muscle and the other one is the internal urethral sphincter. Now, this nerve coming out of the inf mesenteric ganglion, is a part of the hypogastric nerve. the hypogastric nerve goes to the detrusor muscle that releases norepinephrine. also this happens at the spincter. there are receptors on the detrusor muscle- specialised receptors called a beta 3 adrenergic receptor. there is little beta 2 adrenergic receptors. 97 percent is beta 3. when the norepinephrine binds to the receptor of the bladder, it causes potassium ions to leave the detrusor muscle cells, causes relaxation. in other words, it inhibit the receptors that produce kplus to leave the cell causing relaxation. on the sphincters, the receptors are called alpha 1 adrenergic receptor. this receptor, when norepineprine acts onto it causes stimulation and causes the urethra to close. we have other nerves. In the sacrospinal cord , we have the parasympathetic nerves( pelvic nerves) the impulse will come up and activate the sympathetic activity, it comes up to the pons and stimulates it and goes up to the cortex to let it know bladder is empty. the pons has 2 centres( pontine storage centre ... the cerebral cortex will tell the pontine storage center to become activated and it will inhibit another centre - pontine micturition center. what will happen is, descending fibres come down and synapse with the preganlionic fibres that go to the inf mesenteric ganglion. its going to stimulate the sympathetic nerve that will have this flow to the hypogastric nerve, relaxing the smooth muscle of the detrusor wall and keeping the internal urethral sphincter constricted. the fibres continue coming down and stimulates the parasympathetic nerves . these come over here and goes to detrusor muscle and releases ach. these acts on specialised receptors called m3 receptors. however the parasympathetic neurones will be inhibited . if they are inhibited, the action potential that they send is very low. if that is the case they do not act on the receptors. ( when it acts normally, it causes calcium ions to go in and cause contraction). we do not want this to happen in this case. we want to keep it empty. some fibres will synapse on those in the anterior grey horn . this is the pudental nerve. the pudental nerve is part of the somatic nervous system. it goes and acts on the nicotinic type 1receptors of the external urethral sphincter. it releases ach and cause contraction of the muscle. Gives voluntary control of that muscle. Now, when bladder is stretched. ( 15:30 mins) Around 200 mls is when stretch receptors become super activated and sends fast impulses. same thing happens. you become consciously aware of the volume in your bladder. if you cant pee. your actual central centre continues to simulate pontine centre. sympathetic nerve activated. inhibit para and activates somatic nerves to keep external sphincter tight. lets say 400 to 500 mls accumulate. it can extends to up 800 to 1000 mls it can tear above this point. stretch receptors are going to be stimulated. this will go to the actual post grey horn. in the post grey horn, it will send impulses to thoracolumbar region but it does not synapse and passes through. ( note this part). send impulses to cerebral cortex. there are 2 centres as said above. ( pontine micturition and the other one the storage..). cerebral cortex send down axons and synapse with the pontine micturition centre and storage centre. it stimulates the mic centre and inhibit the other one. so now, the axons will come to the thoracolumbar region of the spinal cord ( t11 to L2). they were acting on beta 3 receptors. now, they are not stimulated. impulses decrease or cease. Another one to the internal urethral sphncter will not stimulate it. No more impuslses....... not going to release norepinehrine. it will relax and urine let out. then the descending motor neurones from pontine micturition centre that go to sacral region. the parasym motor neurones. these go to detrusor muscle ( m3 receptors). now they are stimulated. these cause contraction. lots of ach is released. Contraction of the smooth muscle. this squeeze urine out of the bladder. not only that, the internal urethral sphincter relax. urine goes out. remember the somatic motor neurones that control the external urethral sphincter.( nicotinic type 1 receptor). these are no longer stimulated. no action potential and this relaxes. it is inhibited. Urine continue to flow out and we have other muscles that can ic flow of the urine. this helps urine rush out. ( recap is at 25:22 mins of the vid) compostiiton of urine- generally 95 percent water, little sodium, potassium, chloride, magnesium, calcium. decent amount of urea and little bit of uric acid( nucleic acid breakdown products). might be some bicarbonate present. Normally no proteins and red blood cells. lets say the patients urine is not normal- person has glucose in urine- why is it bad? called glycosuria - ... diabtes mellitus. if protein in urine- can be non pathological after exercise or pregnancy, can be normal. lets say it is pathological, you have hbp or heart failure. if you have greater than 150mg/L per day- first sign of renal disease. if ketone bodies in urine- called ketonuria. could be due to uncontrolled diabtes mellitus or due to starvation. high protein high fat diet and no carbohydrates. if you have bilirubin, bilirubinuria- sign of liver disease. ( in cirrhosis or hepatitis or die to obstruction due to gallstone). hemoglobin in urine- had hemolytic anemia ( spherocytosis etc), third degree burns, lots hemoglobin to be lost or mismatched transfusion if you find red blood cells- hematuria and this is usually die to carcinoma, polycystic kidney disease. , trauma, cysts , infection , kidney stones ...can get stuck wbcs in urine- pyuria -sign of UTI.

[@medme2312]

Thank youuu

[@aliahsanshahid8212]

Kahan se copy Kia?

[@ruchitapatil9066]

wowww.. effort!

[@monihy2496]

Mick

[@Theprofessionalsurgeon]

@@aliahsanshahid8212 kia

[@mariaarmas9735]

One day I am gonna hug y'all ninja nerd teachers! And yes after starting residency I will for sure donate. Thanks for sharing knowledge and helping us understand. You are actually helping doctors be better and save more patients. Thank you!

[@obedbagona7402]

Hope to donate too! In the future, God willing

[@khannazmohammad5072]

me too

[@arkanshsharma850]

me too

[@fahadzeeshan7639]

Me too

[@obiwan922]

You have explained the complex detail of micturition reflex into a piece of cake. Ive checked some other popular videos but i found them incomplete or very short or not what i was looking for. So, thanks to you. But It would be more effective if u guys have integrated some pathological situation (as for example, neurogenic bladder) into the video. But overall, its a cool video.

[@NinjaNerdOfficial]

+Obi Wan I'm so glad we were able to help you!!! Thank you for your kind words! Best of luck in your future endeavors!!

[@zaid_alhelu]

Ah yes, the negotiator

[@nicolemarie9019]

Thank you, I just finished the complete playlist for renal, and thanks to you I understand it in a simple but detailed manner.

[@idrisoladosu9078]

I'm on my last one 😀

[@DV-bj9wi]

This renal playlist helped me immensely to prepare for my exams this year. Thank you so much, brilliant teaching, amazing use of the white board, really good explanation. You deserve all the success. You are making us all better doctors, thus changing the world.

[@Stacystann]

i pay 100s of dollars for professors to not teach me, and pay 0 dollars to get a full understanding of anat and physiol. Ultimately, thankful for this channel!

[@jamesdc8330]

do you have a lecture on acid-base balance ? ^*^

[@rajivdhamankar9457]

I have been looking at your videos and enjoying to learn lots this covid 19 lock down has taken me back by 50 years when I was undergraduate student in medical college

[@Sveeramani-rdx]

Please add time stamp for topics ...it will be helpful

[@ayeshasajid1833]

Thank u for making this video.. it helped alot...

[@NinjaNerdOfficial]

So happy we could help you!

[@Theprofessionalsurgeon]

I pay thousands for med school, I swear you deserve millions.

[@dondamishitha468]

Omg 😱🙀🤯 it is soo deep I think if I write✍️ this full mechanism in exam, since my mam don't know this, she may not crt it 😂😂😂😂

[@cathum]

This man has very clear mind and super memory; I have seen his biochemistry videos; quite impressed on how he writes fluently very complex chemical structural diagrams; amazing!

[@jamesmeyer5366]

Oh you are such a good explainer of this urinary system . Its is funny how we just run to the bathroom and urinate and not be thinking of all the complex actions that take place, while doing so. One question if I may . In the male version, during intercourse and onto ejaculation are both sphincters shut simultaneously or one after the other as needed? Reason I ask if the Cowper Gland is flushing out the urethra , pre orgasm, then is external sphincter is open at that point? I get how the Bladder sphincter is definitely closed during orgasm or is it closed from the beginning the point of penile arousal too?

[@kristenharrison9279]

You are a lifesaver with our urinary system! I always search your videos because our teachers don't even lecture when it's a lecture class. They expect us to read and do questions. Not one person I talk to can learn this way. That's why we were here. When i'm done I promise to donate again.

[@bushramemon3734]

Thanks man for your amazing lectures.... You are an absolute life saver 💫

[@aslbekyuldoshev5264]

I'm studying by your videos more than 10 hours a day thank you

[@Ani.DR.07]

Super explaination man. Are u a doc by profession? Your concepts are so clear

[@anjalibhatt4710]

Yes he is His name is Zachary murphy

[@bnanachan7029]

Yes, Professor Zachary Murphy.

[@delrosariorose4369]

Thank you so much for making my med school life easier. Love lots, Rose xoxo

[@AbdirahmanMubarak]

Im having an exam tomorrow. This is what my teacher couldn't explain without loosing me

[@shreyaray5500]

You are a genius, Zach! Thank you for helping me pass my sems

[@jonasasia7267]

Woaw. You are so amazing. Offering more clarity on complex subjects. Am from Ghana and have just finished this entire series today. God richly bless you

[@mosesnchimunya8136]

May God give your good health ninja nerd

[@crazypiper9749]

The best medical lectures on KZbin. I swear!

[@dhuhatahseen1732]

Thank you very much i understand this complex topic by this simple video🌹

[@turkersoykan5695]

Sen nincaların dibisin bilader! Tasaklarına kurban! ❤❤❤🙌

[@meryem-bel]

you're a legend , I deeply appreciate all ur hard work , thanks for making learning fun !

[@SanaBatool-q4k]

now i am your new subscriber..thank you so much... this was a very complicated topic for me.. but bundle of thanks to you Sir for such a great explanation❤️

[@ralphjones9714]

Having no medical training, I want to express my gratitude for creating this video as I feel so much more knowledgeable of the MICTRURITION REFLEX. Now I would like to know if you have a video that explains the physiology of the pelvic floor muscles role in replacing the external sphincter as I no longer have this external sphincter due to prostate removal.

[@geralddzimati72]

Thank you so much Prof Zach for this whole playlist.

[@engwasechimwemwembewe1525]

Thank you so much for this playlist 🙌🏽🙌🏽you are a life saver....cant wait to come back and tell you I passed my physiology exams....thank you

[@johnbenya9558]

First thank you for these videos. As lay person everything makes sense. On a personnel level what could cause the nerves not to sense fullness until 1000 ml. and then allow emptying down to just below 1000 ml. ? I am looking for a solution to a problem on going for 4 years with no infections or other side effects except minor leakage if too much coffee is consumed. SNS did not work due to causing leg pain. Started after a fall on tail bone 4 years ago. I am looking for a list of possibilities to help my Dr. I can live with it. PS I am 75.

[@austinl.2703]

I have the same problem. I don't get a full feeling until 1000 ml and I pee only a little (maybe 200 ml). I insisted the doctor give me intermittent catheters so I didn't need to go to the bathroom constantly. That was 8 years ago. For me , Intermittent catheters were the complete and total relief I needed. No more medicine. No more infections.

[@johnbenya9558]

@@austinl.2703 I want them to find the cause and cure the problem. May have something to do with spinal stenosis. I think it started in 2015 but wasn't told about it and I had no sensation. We will see.

[@TheRealSk8rcruz]

Thank you for helping me understand how head trauma can contribute to urine retention.

[@EricScott-qh5dg]

Oh yeah 😎? Understand that Cobalamin/vitamin B12 is necessary for proper Micturition Reflex. Met a homeless woman who would lose control of her urinary bladder and would be sitting in a chair and suddenly she would be sitting in a pool of urine (probably500-800 ml), because of lack vitamin B12. Her aunt told me when she (her niece) got off the street and ate better, her urinary incontenince would start to improve. The poor woman had absolutely no feelings or knowledge of her bladder. In her case the sudden, violate bladder constriction would force urine back up into her kidneys. Which is an unnatural act. This I understand can damage her kidneys. She's recovering alcoholic. The liver is involved with absorption of B12. Alcohol doesn't help with incontinence. Vegans need to take B12 supplements to avoid losing their bladder control. Curious about where and how B12 affects the nervous system involvement in the Micturition Reflex?

[@AquaDoll34]

Thank you so much! I especially love how you recap everything at the end 36:20 it makes understanding so much better because it revises what you just learnt! Thanks! this is amazing!

[@lucychipendo5676]

Thank you so much ..You guys have helped me through my medical year

[@mosesnchimunya8136]

We thank God for the gift in you

[@malladiprasad2143]

Hi After reading further, there are many inconsistencies in your explanation. Mainly the afferent pathways.. How the detrusor muscle send afferent signals ? Trough pudendal nerve or parasympatheti afferent pathways ? If through parasympathetic afferent pathway then your diagram is wrong. If through pudendal sensory nerve then one is always conscious of filling their bladder. how the pudendal nerve interact at the thoracic level. Please revisit these inconsistencies. it is now way finding a fault in you but the context does not make sense. best wishes

[@shivanishivani4705]

Thanks for this better and beautiful explaination 👏

[@livelaughlove6952]

I love your teaching dearly, and appreciate your videos so much, but why do you pronounce certain words so oddly? No shade, but I've noticed it for about a year now and its really getting to me lol. I promise no shade, just wondering if its intentional?

[@ImKl0x]

24:43 لاااا بال على روحه

[@lauramaable]

Dear Zach, you should do a review of chronic kidney disease

[@NinjaNerdOfficial]

This topic is on the list!

[@obiwan922]

may I please request you to make a video on neurogenic bladder (UMN type, LMN type bladder dysfunction). TIA.

[@wongkl7804]

Thank you for the video,you were a great help! Keep up the good work :)

[@NinjaNerdOfficial]

+Nikita ATikin I'm so happy it was helpful!!!

[@nisiavilella9377]

I loved this class!! Congrats!!! I Would like to know what is the relation of the vagus nerve and the micturition reflex? Thanks!!!

[@becherkapuka1149]

This is beautiful,thanks very much Ninja Nerds science

[@zinalarfi4868]

Hope you are muslim... Knowledge leads U to believe in Allah and mohamed the messenger of Allah...

[@fabianazaninotti2176]

u guys are A-MAZING!!! THANKS for you hard work!!!!

[@mikec5391]

So what happens if your INTERNAL sphincter is dysfunctional and doesnt close all the way or lets say its just weaker, would that cause a frequent urge to urinate since now only your external sphincter is holding urine in? I suspect that might be happening to me.

[@jerrysegal2903]

great question

[@planetearth1713]

@mike C if there is a problem in functioning of internal spincter , then there will be difficulty in passing the urine as in normal state spincters are in contracted state and require signals in response to which they will dilate and allow the passage of urine .

[@mikec5391]

Right but what if its the other way around and the internal sphincter is loose or not contracted all the way in which urine leaks constantly into your prostatic urethra and now is only being held by the external sphincter

[@drashtisutariya61]

I have a question that is the glucose apeare in urine is it necessary that it is DM i mean can it due to problem in PCT?

[@obedbagona7402]

One suggestion: You may want to rename this video into "Micturition Reflex and the Urine" Or add something like "Urine Composition" The last part was SUPER important and maybe people won't click this video because they'll think it's just about Micturition reflex. Again, much love Ninja Nerd! - Grateful Filipino medical student

[@vikrampal9899]

Nice work sir ... your videos are really helpful and the complex concepts that you simplify with so much enthusiasm is just extraordinary.. Thank you sir ..

[@pluto4479]

Please also make more videos on 2nd year .you r the best

[@ayushikeshare398]

kindly explain What type of neurogenic bladder a patient has in following condition , if: A: injury above sympathetic supply B : at the level of sympathetic supply of bladder C: in b/w sympathetic and parasympathetic region.

[@aleenafarooqui3890]

I love you. I mean it. Just finished all of renal physiology and I can say, I’ve never understood things this beautifully, it takes me half an hour to revise the whole thing now❤ thank you ninja nerd truly

[@austinl.2703]

I use intermittent catheters. Somehow I never get the relax signals. 1200 ml hurts pretty bad. Now I get a full signal around 700 ml.

[@kallacharib1162]

Please make video on cystometrogram part of bladder on micturition reflex

[@Ag_paul]

Tomorrow am sitting a physiology paper on renal systems Thank you Zack Murphy 🙏 Your content is golden.. Unmatched 💫💫

[@mojubyleen]

I hope it went welll!

[@AureliaTata-k3u]

I'm sitting a renal exam tomorrow 😅😅

[@mojubyleen]

@@AureliaTata-k3u i hope it goes well. ❤

[@medlifeinternational.9319]

wow! great work done

[@siddharthsingh4354]

why do you make things complicated first tell the name of the structure then its function

[@mikec5391]

When you say 400-500 is usually when people just start urinating does that mean they start losing control and peeing themselves or thats how long people hold it to until they decide to rush to the bathroom. Not sure what you meant by the way you said it

[@abhanshul]

Pls make a video on various lesions of neurogenic bladder

[@mjclaudianava5397]

Hi, doesn't the afferent pelvic nerve also synapse with the efferent parasympathetic at the sacral level? I think that would explain micturition reflex during conus medullaris level or UMN type of spinal cord lesions.

[@WLDORPFELD]

Wow, what an education! I now have whole new respect for my urologist. I had prostate cancer about 10 years ago, which was successfully treated with external beam radiation. I'm now experiencing frequent urination. Sometimes every 10-15 minutes. I have some spinal stenosis. My urologist will be investigating that soon. My frequency varies dramatically at times. Sometimes I can as long as 2 hours.

[@vyomatrivedi1812]

nice explanation but can u help us by describing tract carrying sensation like how pelvic nerves carry information upto cortex and signaling between cortex and pons

[@k.i.d285]

you are great!!!!! , thank you sooo much. All love from Palestine.

[@فطم-ر3خ]

Finished all 10 videos 😀👏 thank u zach (if this was ur name am not sure ) whatever u r my herrooo🤯⭐️💪🏻

[@shajankoshy1681]

Your detailed discussion really impressive and understandable for the students

[@meriember8782]

You are a king thank you for helping us you are a legend♥️♥️♥️♥️

[@rohandutta8296]

Sir, will you please explain what's the difference between autonomic nervous system and somatic nervous system? Please Sir....

[@charoopiplani5595]

What tracts do all these fibres coming down from the cortex and pons form? Occlusion of anterior spinal artery results in spastic bladder, which is because of the loss of the inhibitory control. So what part do these inhibitory control fibres lie in?

[@elishabach-price609]

Really useful. It helped that you repeated the simple version and Pons as well, as some other Micturition reflex videos left that out so thank you :)

[@MPRetSPORT]

You are the best

[@rubaalbarghouthi]

Amazing video as usual. I can't thank you enough for your fascinating job 👏 🙌 👍

[@MultiZirkon]

A bit too much repetition in this one video. Made it a bit hard to follow.

[@RambabuLakavath]

Now I completed complete renal physiology. I can’t express may Joyner’s after hearing these lectures

[@tlv6701]

Could you do a clearence video :(? Thank you

[@varshamittal3564]

Sir , can u upload the video on urinary dysfunction or neurogenic dysfunctions ? Plz sir .....

[@Novak000]

I fractured my lowel lumbar l2 and now I have problems with bladder truble starting urinating it jest feels weird u think it is because of the fracture pressing on my nervs???

[@دكتورسراججابر]

Very good leacture but it is better to ad with it pathological condition like trauma to spinal cord at diffrent levels

[@asmakhanbaber9963]

Sir, how does parasympathetic nervous system causes internal urethral sphincter relaxation??

[@user-jhsoshxhs33]

Alpha 1 causes construction & Parasympathetic causes relaxation

[@zohaibrashid1479]

what are the stretch receptors? is it beta adrenergic receptor?

[@zabcdefghijklmnopqrstuvwxy114]

No they both are different stretch receptor : access if any stretch changes occur at urinary bladder and inform about if changes occur to sensory neurone to sacral sagment , and beta adrenergic are receptor activated by sympathetic activation and cause relaxation of detrusour muscle.

[@ayushikeshare398]

Finally I got the best video lecture on this topic. Students it is lengthy but do watch this video for once. You won't need any other reference

[@SinusofMorgagni42865]

Zach please make do a lecture on Atonic, automatic and neurogenic bladders 🙏🏻

[@NikhilAnand_SCI]

I find it very interesting I m paralysed patient .. and I hv problem of bladder .. will learn n spread to my paralysed patient subscriber...thank u ...

[@mukhujjye_21]

Again topic is crystal cleared 😀 THE SAVIOUR 🔥🙏🏽

[@roronoazoro3204]

I will surely donate this generously respectful smart young man when I graduate

[@fatimaanugrahlall3414]

U r Lyk Ninja hatori have the Ninja technique to make everything easy 😊

[@haznulhafizzih.k3272]

nice video. Really help me a lot. It would be nice if this topic integrated with other pathological associated disease that affect this micturition process like bingn prostatic hyperplasia

[@jrockisu1289]

Great video, helping a PA student survive brother.

[@اذيابالسريسي]

🌷🌷🌷🌷

[@kawserjahan306]

Can u explain uninhibited neurogenic bladder

[@gabrielepuccetti9786]

ma per caso sei rinchiuso nel garage di Tozzi?

[@paultorres1384]

Thank you, Professor! Best video on the subject of the micturition reflexes!

[@yugandharkakad8077]

Can you make videos on histology all epithelium there location and function

[@SnapStats247]

I peed a lot after watching this video😂😂🤣🤣😁😁

[@ramithansda8397]

Sir will You make a video on Abnormal conditions of Bladder

[@dhritidasstudy9337]

🙇