Anatomy

Question 1

Surface marking of external inguinal ring

Answer 1

Pubic tubercle

Question 2

Label picture 4

Answer 2

See picture 5

Question 3

Main function of bladder neck?

Answer 3

• Circular smooth muscle
• Contract during orgasm causing prograde ejaculation in males
• poorly developed in females

Question 4

Name the 4 narrowest passage points for upper tract stones

Answer 4

• Ureteropelvic junction
• pelvic brim
• under vas deferens / broad ligament
• ureterovesical junction

Question 5

Anatomy parts of urethra? (5)

Answer 5

Posterior urethra
• prostatic urethra: bladder neck to end of prostate. Receives ejaculatory and prostatic ducts. Widest and most dilatable.
• membranous urethra: end prostate to beginning penis. Pass through pelvic floor and deep perineal pouch. Surrounded by external urethral sphincter. Narrowest and least dilatable.

Anterior urethra
• bulbar urethra: under scrotum and perineum between scrotum and anus
•Penile (spongy) urethra
• glanular urethra: end part in glans penis

Question 6

Name 10 causes urethral stricture

Answer 6

Trauma
• external blunt trauma:
-Membranous urethra injury associated with pelvic #
- bulbar: trauma to perineum, fall astride
-Penile: associated with fractured penis
•. external penetrating trauma: commonly gun shot wounds to penile urethra but can be anything anywhere
• internal iatrogenic trauma with catheter
- temporary indwelling catheter eg peri-op. Commonly submeateal (glanular) and bulbar
-Inadvertent inflation balloon in urethra
• internal iatrogenic trauma with urological procedures
- resectoscope for TURP or turbt
-Lithotrite for endoscopic treatment bladder stones

Inflammatory
• urethritis
- gonorrhoea: infection periurethral glands, healing with spongiofibrosis. Often multiple strictures due to re-infection
-Chlamydia
• bx0/ lichen sclerosis : meatal and submeatal stenosis

Radiotherapy for prostate and bladder cancer

Malignancy
• primary squamous carcinoma of urethra: rare, usually bulbar
• prostate cancer: membranous and proximal bulbar urethra

Congenital: failure of normal canalization (post urethral valves)

Question 7

Name 8 complications urethral stricture

Answer 7

Local
• periurethral abscess
• necrotising fasciitis of perineum
• perineal fistula (rupture periurethral abscess)

Complications of bladder out flow obstruction: chronic renal failures, UTI, bladder stone, urinary retention, bladder diverticulum

Question 8

Weakest point of bladder?

Answer 8

Dome