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3rd Year Summary > Anatomy 5: Urinary Incontinence and Prolapse > Flashcards

Anatomy 5: Urinary Incontinence and Prolapse Flashcards

1
Q

What are the 3 components which made up the pelvic floor?

A

Pelvic diaphragm
Muscles of perineal pouches
Perineal membrane

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2
Q

What are the two groups of muscles which make up the pelvic diaphragm?

A

Levator ani

Coccygeus

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3
Q

What passes through the pelvic diaphragm?

A

Urogenital hiatus

Passage for urethra and vagina

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4
Q

What are the 3 parts of the levator ani?

A

Puborectalis
Pubococcygeus
Iliococcygeus

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5
Q

Where does the Levator Ani attach?

A
  • Pubic bones, ischial spines and tendinous arch of levator ani
  • Perineal body, coccyx and walls or organs in midline
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6
Q

What innervates the levator ani?

A 
Pudendal nerve (S2,3,4)
Nerve to Levator Ani (S3,4,5)
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7
Q

What are the supporting ligaments/fascia of the pelvic organs?

A

Endo-pelvic fascia

Pelvic ligaments

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8
Q

What are the Pelvic Ligaments?

A
  • Fibrous Endo-pelvic fascia
  • Uterosacral
  • Transverse cervical
  • Lateral ligament of bladder
  • Lateral rectal ligament
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9
Q

Where is the deep perineal pouch?

A

Lies below the fascia covering the inferior aspect of the pelvic diaphragm

Lies above the perineal membrane

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10
Q

What does the Deep Perineal Pouch contain?

A
  • Part of the urethra (and vagina in females)
  • Bulbourethral glands in males
  • Neuromuscular bundle for penis/clitoris
  • Extensions of the ischioanal fat pads and muscles
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11
Q

What is the difference between the deep transverse perineal muscle in the males and females?

A

In males there is the bulbourethral gland

In females, just smooth muscle

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12
Q

Where is the location of the perineal membrane?

A

Superficial to the deep perineal pouch
Thin sheet of tough, deep facia
Attaches laterally to the sides of the pubic arch, closing the urogenital triangle

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13
Q

What are the features of the Perineal Membrane?

A

Opening for the urethra (and vagina in females)

Together with the perineal body, it is the last passive support of the pelvic organs)

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14
Q

Where is the location of the superficial Perineal Pouch?

A

-Lies below the perineal membrane

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15
Q

What makes up the superficial perineal pouch in males?

A

Contains the root of the penis:

  • Bulb (corpus spongiosum and corpus cavernousum)
  • Associated muscles (bulbospongiosus and ischiocavernosus)
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16
Q

What makes up the superficial perineal pouch in females?

A

Contains female erectile tissue and associated membrane:

  • Clitoris and Crura (corpus cavernosum)
  • Bulbs of vestibule (paired)
  • Associated muscles: bulbospongiosus and ischiocavernosus
17
Q

What 3 factors does urinary incontinence depend on?

A
  • Urinary bladder neck support
  • External urethral sphincter
  • Smooth muscle in urethral wall
18
Q

How can prolapse be repaired surgically?

A

Sacrospinous fixation

Incontinence surgery

19
Q

What is sacrospinous fixation?

A
  • Sutures placed in sacrospinous ligament
  • Just medial to the ischial spine
  • To repair cervical/vault descent
  • Performed vaginally
  • Risk of injury to pudendal NVB and sciatic nerve
20
Q

What is incontinence surgery?

A
  • Trans-obturator approach
  • Mesh through obturator canal
  • Create a sling around the urethra
  • Incisions through vagina and groin
21
Q

What is the nerve roots of the detrusor muscle?

A

Supplied primarily by parasympathetic nerves derived from pelvic splanchnic nerves S2,3,4

22
Q

What is the nerve roots the urethral smooth muscle?

A

Supplied primarily by sympathetic nerves derived from spinal cord at T10-L2

23
Q

What predominates during bladder filling- sympathetic or parasympathetic?

A

Sympathetic to allow bladder muscle to relax

24
Q

At what ml is there usually a desire to micturate?

A

About 400mls

25
Q

What happens in the voiding stage?

A
  • The parasympathetic supply (via the pelvic Splanchnic nerves S2,3,4) causes detrusor contraction and urine enters the urethra
  • The pudendal nerve (S2,3,4) ensures relaxation of the external urethral sphincter and pelvic floor
26
Q

How is the micturition reflex initiated?

A

The sense of urine in the urethra is via the pudendal nerve

27
Q

What does the term “vulva” relate to?

A

The collective name given to the female urogenital triangle structures: the mons pubis, labia majora, labia minora, vestibule, vaginal orfice, orfices of the vestibular glands and clitoris

3rd Year Summary (17 decks)

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