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BRS UROLOGY & RENAL > 1b Urinary Incontinence and BPH > Flashcards

1b Urinary Incontinence and BPH Flashcards

1
Q

What are the three anatomical locations in which the ureters are slightly constricted?

A

pelvic ureteric junction (PUJ/UPJ), pelvic brim (crossing iliac vessels), as it passes through the bladder wall (uretero-vesicul junction/ UVJ)

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2
Q

What are the 3 layers of the ureter called?

A

Ureters 3 layers of tissue-outer fibrous tissue, middle muscle layer and inner epithelium layer

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3
Q

what is the nervous supply of the ureters?

A

autonomic

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4
Q

What does the left ureter drain into in terms of lymphatics?

A

drains into left para-aortic nodes

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5
Q

what does the right ureter drain into in terms of lymphatics?

A

right paracaval and interaortocaval lymph nodes

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6
Q

What is the normal length of a ureter?

A

25 cm

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7
Q

What are the components of the female GU system?

A

2 kidneys, 2 ureters, urinary bladder and urethra

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8
Q

What is the function of the kidneys?

A

Kidneys remove waste products of metabolism, excess water and salts from the blood and maintain the pH.

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9
Q

what type of organ is the bladder when it is empty?

A

When empty, bladder is pelvic organ, when distended it rises up to abdominal cavity and becomes an abdomino-pelvic organ.

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10
Q

What are the three layers of the bladder?

A

outer loose connective tissue, middle smooth muscle and elastic fibres and inner layer lined with transitional epithelium.

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11
Q

What is the blood supply of the bladder?

A

superior and inferior vesical branches of internal iliac artery. Drained by vesical plexus which drains into internal iliac vein

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12
Q

What type of muscle is the internal urethral sphincter?

A

smooth muscle - involuntary control

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13
Q

What type of muscle is the external urethral sphincter?

A

skeletal muscle - under voluntary control

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14
Q

What is the blood supply of the urethra (female)?

A

Internal pudendal arteries and inferior vesical branches of the vaginal arteries with corresponding venous drainage

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15
Q

What is the nervous supply to the urethra?

A

vesical plexus and the pudendal nerve

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16
Q

What muscle is the triangle at the urethral opening?

A

Trigone muscle

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17
Q

What is the venous drainage of the bladder in males?

A

venous drainage by prostatic venous plexus which drains into internal iliac vein

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18
Q

what is the prostate?

A

Gland lying below the bladder in the male and surrounds the proximal part of the urethra (prostatic urethra). Function is to secrete 75% of seminal fluid which liquifies coagulated semen after deposition in the female genital tract.

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19
Q

What is the blood supply of the prostate?

A

inferior vesical artery, urethra- bulbourethral artery and internal pudendal artery with corresponding venous drainage

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20
Q

What does the urethra travel through (male)?

A

runs through neck of bladder, the prostate gland, the floor of pelvis and the perineal membrane to the penis and external urethral orifice at the tip of the male penis

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21
Q

What are the three parts of the male urethra?

A

Prostatic, membranous and spongy

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22
Q

What is the nerve supply to the male urethra?

A

prostatic plexus

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23
Q

Describe the filling phase of micturition?

A

bladder fills and distends without rise in intravesical pressure. Urethral sphincter contracts and closes urethra

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24
Q

Describe the voiding phase of micturition?

A
  • bladder contracts and expels urine
  • urethral sphincter relaxes and urethra opens allowing flow
  • Bladder should empty fully
  • 6 pees daily, 20s each= apps 2 mins daily voiding
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25
Q

how does micturition work in infants?

A

micturition is a local spinal reflex in which bladder empties on reaching a critical pressure.

26
Q

Describe how voiding of urine can occur in adults but not infants?

A

In adults voiding can be initiated or inhabited by higher centre control of the external urethral sphincter keeping it closed until it is appropriate to urinate

27
Q

Which part of the brain is involved in the control of urination?

A

pons in the medulla

28
Q

What nerve is the external sphincter under the control of during micturition?

A

Somatic motor fibre of pudendal nerve

29
Q

Which nerve fibres control the internal sphincter?

A

Motor fibres of the parasympathetic pelvic nerve

30
Q

What detects the change in the amount the bladder has filled?

A

Stretch receptors M3 in the bladder send signals along the sensory nerve

31
Q

What does activation of the Ms receptors result in?

A

As they become stretched and stimulated this results in contraction of the detrusor muscle for urination.

At the same time the parasympathetic fibres inhibit the internal urethral sphincter which causes relaxation and allows for bladder emptying.

32
Q

What allows the bladder to fill again when it has been emptied?

A

When the bladder empties of urine the stretch fibres become inactivated,

  • the sympathetic nervous system (originating from T11-L2) is stimulated to activate the beta 3 receptors causing relaxation of the detrusor muscle allowing the bladder to fill again.
33
Q

What is meant by stress urinary incontinence?

A

Complaint of involuntary leakage on effort or exertion, or on sneezing or coughing

34
Q

What are the risk factors for stress urinary incontinence?

A

ageing, obesity, smoking, pregnancy and route of delivery

35
Q

What is the pathology behind stress urinary incontinence?

A

impaired bladder and urethral support and impaired urethral closure

36
Q

Which muscle is relaxed in stress urinary incontinence?

A

External urethral sphincter

37
Q

What are the signs and symptoms of stress urinary incontinence?

A

Involuntary leakage from urethra with exertion/effort or sneezing or coughing

38
Q

What urodynamic investigations might be done for stress urinary incontinence?

A

urodynamics-urinary leakage during an increase in intrabdominal pressure in the absence of a detrusor contraction

39
Q

What is the management of stress urinary incontinence?

A

Non surgical-physio with PFE (pelvic floor exercises)
Surgical-mid urethral sling, colposuspension, periurethral bulking agents

40
Q

What is meant by an overactive bladder? Also known as Urge Urinary Incontinence

A

urinary urgency, usually with urinary frequency and nocturia, with or without urgency urinary incontinence

41
Q

What are the risk factors for Overactive Bladder?

A

age, prolapse, increased BMI, IBS, bladder irritants (caffeine, nicotine)

42
Q

What is the pathology indicated in over active bladder?

A
  • involuntary detrusor muscle contractions
43
Q

What are the signs and symptoms of overactive bladder?

A

urgency, frequency, nocturia and urgency incontinence, impact on QOL-sleep disorders, anxiety and depression.

Assess for enlarge prostate in males and prolapse in women

44
Q

What investigations should be done for overactive bladder?

A

exclude infection with urine dip/MSU
voiding diaries
assess post void residual
Urodynamics
cystoscopy

45
Q

What are the management principles of Overactive Bladder?

A

Behavioural/lifestyle changes
Bladder retraining
Antimuscarinic drugs
Beta-3 agonists
BOTOX
Neuromodulation (PTNS/SNS)
Surgical:Augmentation cystoplasty and urinary diversion

46
Q

What is overflow incontinence?

A

Involuntary leakage of urine when bladder is full. Usually due to chronic retention secondary to obstruction or an atonic bladder

47
Q

What might be causing overflow urinary incontinence?

A

Outlet obstruction (faecal impaction/BPH)
Underactive detrusor muscle
Bladder neck stricture
Urethral stricture
DHx-alpha adrenergics, anticholinergics, sedative
Bladder denervation following surgery

48
Q

what is continuous incontinence?

A

Continuous loss of urine all the time. Could be due to vesicovaginal fistula, ectopic ureter(from kidney to urethra or vagina)

49
Q

What is functional incontinence?

A

due to severe cognitive impairment or mobility limitations, preventing use of the toilet. Bladder function is normal

50
Q

What is BPH?

A

non malignant growth or hyperplasia of prostate tissue, common cause of lower urinary tract symptoms in men

51
Q

What are the risk factors for BPH?

A

hormonal effects of testosterone on prostate tissue

52
Q

What is the pathology associated with BPH?

A

hyperplasia of both lateral lobes and the median lobes, leading to compression of the urethra and therefore bladder outflow obstruction. See hyperplasia of the stroma (smooth muscle and fibrous tissue) and glands

53
Q

What are the signs and symptoms of BPH?

A

hesitancy in starting urination
poor stream
dribbling post micturition
frequency, nocturia
can present with acute retention

54
Q

what are some red flag conditions which could cause similar symptoms to BPH?

A

Bladder/prostate cancer
Cauda equina
High pressure chronic retention

55
Q

What are some investigations for BPH?

A

Urine dip / Voiding Diary
PSA - to predict prostate volume when combined with MRI
Ultrasound
Cystoscopy - if concerned about cancer

56
Q

What are the lifestyle management principles of BPH?

A

Lifestyle: weight loss, reduce caffeine and fluid intake in evening, avoid constipation

57
Q

What are the two medications used to treat BPH?

A

alpha adrenergic antagonist e.g. Tamsulosin
5-alpha reductase inhibitor e.g. Finasteride

58
Q

How do alpha blockers work to help BPH?

A

blocker-alpha 1-AR present on prostate stromal smooth muscle and bladder neck. Blockage results in relaxation , thus improving urinary flow rate

59
Q

How do 5-alpha reductase inhibitors help BPH?

A

inhibitor-prevents conversation of testosterone to DHT (which promotes growth and enlargement of prostate) so results in shrinkage, thereby improving urinary flow rate and obstructive symptoms

60
Q

What surgery can be done for BPH?

A

transurethral resection of the prostate (TURP)-debulks prostate to produce adequate channel for urine to flow

61
Q

What are the complications associated with BPH?

A

progressive bladder distention, causing chronic painless retention and overflow incontinence.

If undetected can lead to bilateral upper tract obstruction and renal impairment, with patient presenting with chronic renal disease

BRS UROLOGY & RENAL (11 decks)

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