Proses Berkemih

Moganasivan S 1301-1211-3074

Proses mikturasi
The basic process of normal urination (or

"micturition") can be broken down to:

Urine is made in the kidneys II. Urine is stored in the bladder III. The sphincter muscles relax IV. The bladder muscle (detrusor) contracts V. The bladder is emptied through the urethra and urine is removed from the body.
I.

Bladder
The bladder is composed of bands of interlaced smooth muscle (detrusor). The innervation of the body of the bladder is different from that of the bladder neck. The body is rich in beta adrenergic receptors. These receptors are stimulated by the sympathetic component of the autonomic nervous system (ANS). Beta stimulation, via fibers of the hypogastric nerve, suppress contraction of the detrusor. Conversely, parasympathetic stimulation, by fibers in the pelvic nerve, cause the detrusor to contract. Sympathetic stimulation is predominant during bladder filling, and

Storage
The filling of the bladder is enabled by:
contraction of the striated sphincter (somatic

innervation) contraction of smooth muscle sphincter (sympathetic innervation) inhibition of detrusor activity (sympathetic innervation)

Emptying
Voiding (micturition) is enabled by:
relaxation of the striated sphincter (somatic

innervation) relaxation of the smooth muscle sphincter and opening of the bladder neck (sympathetic innervation) detrusor contraction (parasympathetic innervation)

Internal Sphincter
Two sphincters control the bladder outlet. The internal

sphincter is composed of smooth muscle like the detrusor and extends into the bladder neck. Like the detrusor, the internal sphincter is controlled by the ANS and is normally closed. The primary receptors in the bladder neck are alpha-adrenergic. Sympathetic stimulation of these alpha receptors, via fibers in the hypogastric nerve, contributes to urinary continence.

External Sphincter
The external sphincter is histologically different

from the detrusor and internal sphincter. It is striated muscle. Like skeletal muscle, it's under voluntary control. It receives its innervation from the pudendal nerve, arising from the ventral horns of the sacral cord. During micturition, supraspinal centers block stimulation by the hypogastric and pudendal nerves. This relaxes the internal and external sphincters and removes the sympathetic inhibition of the parasympathetic receptors. The result is unobstructed passage of urine when the detrusor contracts.

Summary
Normally, we are able to control where and when

we void. This is largely because the cerebrum is able to suppress the sacral micturition reflex. If the sacral reflex is unrestrained, parasympathetic stimulation via the pelvic nerve causes detrusor contraction. Detrusor contraction is suppressed by alpha and beta sympathetic stimulation via the hypogastric nerve. In response to afferent stimulation, the cerebrum becomes aware of the need to void. If it is appropriate, the cerebrum relaxes the external sphincter, blocks sympathetic inhibition, the bladder contracts and urine is expelled.