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FUNGSI MIKSI

Proses miksi
Pengisian

( filling )
Pengosongan ( storage )

Laplace's equation

Laplace's equation states that there is a direct


relationship between wall tension and intravesical
pressure and bladder size.
T is tension,
P is intravesical pressure,
R is bladder radius, and
d is wall thickness.
During bladder filling, Pves is relatively constant.
With a fully
distended bladder, d, because of its relative
thinness, is ignored relative to the other parameters
unless a hypertrophied wall exists.
Thus, T=P R/2 approximates tension in the full
normal bladder

THE URINARY BLADDER


The bladder performs several important functions.

First, it must store a socially adequate volume of urine.


The bladder wall must be able to stretch and rearrange itself to allow
an increase in bladder volume without significant rise in pressure.
In other words, the bladder wall must be extremely compliant.

Second, the smooth muscle and intrinsic nerves have to be protected


from exposure to urine by the urothelium, which itself must also
expand readily during filling.

Third, bladder emptying requires synchronous activation of all the


smooth muscle, because if only part of the wall contracted, the
uncontracted compliant areas would stretch and prevent the increase
in pressure necessary for urine to be expelled through the urethra.
This is the problem often seen in an elderly man with benign prostatic
hyperplasia who develops urinary retention and a bladder
diverticulum.

Smooth Muscle
There are several universal characteristics of smooth muscle:

Smooth muscle consists of a sheet containing many small,


spindle-shaped cells linked together at specific junctions. Smooth
muscle cells contain actin and myosin, but these proteins are not
arranged in a regular sarcomere pattern. Instead, each smooth
muscle cell consists of a more variable matrix of contractile
proteins that is attached to the plasma membrane at the
junctional complexes between neighboring cells.

Smooth muscle maintains a steady level of tension that can be


modulated by circulating hormones, by local factors such as nitric
oxide, or by activity in the autonomic nerves.

Smooth muscle is more adaptable than skeletal muscle and is able


to adjust its length over a much wider range than skeletal muscle.

Based on the assumption of a spherical bladder, the


circumference of a 400-ml capacity bladder is
approximately 30 cm.
If the bladder empties to a residual urine volume of 10 ml,
the circumference would be only 8 cm.
To accomplish this feat, the detrusor would have a change
in muscle length of 75%.
If the bladder were to be made of skeletal muscle instead,
the maximum length change would be only about 30%.
The maximum "skeletal muscle bladder" emptying would
be only 70% of its contents, leaving a residual urine of 120
ml.
Thus, the bladder requires the unique property of smooth
muscle to accomplish its job. What is assumed to be the
stronger skeletal muscle is not up to the job of bladder
emptying

Smooth Muscle
There are several universal characteristics of smooth muscle

Smooth muscle consists of a sheet containing many small,


spindle-shaped cells linked together at specific junctions.
Smooth muscle cells contain actin and myosin, but these proteins
are not arranged in a regular sarcomere pattern.
Instead, each smooth muscle cell consists of a more variable
matrix of contractile proteins that is attached to the plasma
membrane at the junctional complexes between neighboring cells.

Smooth muscle maintains a steady level of tension that can be


modulated by circulating hormones, by local factors such as nitric
oxide, or by activity in the autonomic nerves.

Smooth muscle is more adaptable than skeletal muscle and is able


to adjust its length over a much wider range than skeletal muscle .

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