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3 REN > AP03 Urinary Continence > Flashcards

AP03 Urinary Continence Flashcards

1
Q

name 5 types of urinary incontinence

A 
stress
urge
overflow
functional
mixed
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2
Q

Which ligaments support the area surrounding the neck of the bladder?

A

lateral and medial puboprostatic ligaments

lateral ligament

posterior ligament

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3
Q

What is a cystocoele?

A

a prolapsed bladder, where it bulges into the vagina

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4
Q

How would you treat a cystocoele?

A 
activity changes
kegel exercises
surgery
HRT
Pessary
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5
Q

What is a pessary?

A

a device to support the structure of the vagina

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6
Q

What stimulates parasympathetic bladder control?

A

afferent of full bladder

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7
Q

What nerve is involved in parasympathetic bladder control??

A

Pelvic nerve

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8
Q

Where does the pelvic nerve originate from?

A

S2-4

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9
Q

Where are the pelvic nerve parasympathetic ganglia?

A

bladder wall

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10
Q

What does parasympathetic innervation of the bladder stimulate?

A

muscle contraction and bladder emptying

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11
Q

What is the sympathetic afferent of the bladder stimulated by?

A

urine increasing bladder pressure

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12
Q

What nerve mediates sympathetic control of the bladder?

A

Hypogastric nerve

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13
Q

Where does the hypogastric nerve originate from?

A

T10-L2

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14
Q

What does sympathetic innervation of the bladder stimulate?

A

IUS contraction

bladder filling

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15
Q

What mediates somatic control of the bladder?

A

Pudendal nerve

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16
Q

Where does the pudendal nerve originate from?

A

S2-4

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17
Q

What muscles does the pudendal nerve supply?

A

bulbospongiosus
ischiocavernosus
Levator Ani
EUS

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18
Q

By what age is the bladder stretch reflex developed?

A

3-5 years olf

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19
Q

What does it mean to be enuretic?

A

you fail to develop voluntary control over urination

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20
Q

How might a stroke cause functional incontinence?

A

lower limbs less active so can’t get to the toilet in time

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21
Q

How might a stroke cause pontine incontinence?

A

damage to the pons inhibits the action of the pontine urinary centre

inability to store urine

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22
Q

What happens in damage to the pontine continence centre?

A

sympathetic input to the bladder is lost
inability of the detrusor muscle to relax or IUS to contract

the bladder hence empties as it fills

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23
Q

Do mild symptoms of benign prostate enlargement need treatment?

A

nope

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24
Q

What is AUR?

What should you do?

A

acute urinary retention

A and E quick time

25
What is a cystoscopy?
a thin tube with a camrea is inserted through the urethra LA administered
26
What is photoselective vaporisation?
cystoscope inserted into prostatic urethra | laser destroys obstructive tissue
27
Why might alpha reductase inhibitors be used to treat benign prostate enlargement?
they prevent the conversion of testosterone to DHT DHT causes prostatic hyperplasia
28
Which part of the prostate is the bit which enlarges?
transitional zone
29
What is the best way to test for benign prostate enlargement?
digital rectal examination
30
How might a digital rectal examination help differentiate between cancerous / no cancerous enlargement?
hard nodule - cancer soft protrusion - BPH not always tho so watch out xxx
31
What are the two main sites for spongy urethral tear?
inferior to urogenital diaphragm | superior to urogenital diaphragm
32
What might cause a spongy urethral tear inferior to the urogenital diaphragm?
straddle injuries
33
Which is more common: partial disruption of the anterior urethra complete tear?
partial disruption
34
How may classifications of urethral ruptures superior to the urogenital diaphragm are there?
5
35
What is type I superior rupture?
stretching of posterior urethra
36
What is type II rupture?
posterior urethral injury above urogenital triangle
37
What is type III rupture?
injury to membranous urethra
38
What is type IV rupture?
bladder base injury involving bladder neck to proximal urethra
39
What is type IVa rupture?
bladder base injury, not involving bladder neck
40
What is type V rupture?
anterior urethral injury
41
When would you treat and anterior urethral injury?
immediately after diagnosis
42
How would you treat anterior urethral injuries?
bladder catheter 14-21 days | X -ray to check healing
43
When would you treat a posterior urethral injury?
not quickly, associated with other injuries
44
How would you treat a posterior urethral injury?
catheter in place for 3-6 months wait for boddy to resorb swelling from pelvic fracture surgery to reconstruct urethra
45
What might cause type I urethral injury?
rupture of puboprostatic ligament
46
What does type II urethral injury cause?
extraperitoneal extravasation of urine with retropubic space of REtzius
47
What does type II urethral injury cause?
extraperitoneal extravasation of urine | urine does not extend into the thigh or anal triangle
48
What does type IV urethral injury cause?
extraperitoneal extravasation of urine within retropubic space of Retzius
49
What does a suprapubic catheter pass through?
skin subcutaneous tissue rectus fascia preperitoneal space
50
What allows a suprapubic catheter entry into the bladder?
cystostomy
51
What are CAUI?
catheterisation-associated urethral injury
52
What structures are at risk with CAUI?
``` urethra prostate bladder pelvic floow corpus spongiosum of penis ```
53
What structures are at risk with a suprapubic catheter?
``` bowel abdominal contents (rare) external iliac injury ```
54
What sorts of patients are at greater risk of external iliac injuries in suprapubic catheterisation?
obese patients
55
What urinary function would be lost in damage to T12-L2?
sympathetic control of micturition (innervation of detrusor and IUS)
56
What urinary function would be lost in damage to S2-S4?
parasympathetic control of detrusor | pudendal nerve responsible for EUS damaged
57
What symptoms would be associated with S2-S4 damage?
``` overlfow incontinence straining in urination inability to empty a full bladder urinary infections pain / burning in urination blood in urine lower abdo pain ```
58
What symptoms might be associated with T12-L2 damage?
urinary incontinence rashes / sores (skin is wet) UTI symptoms nocturia

3 REN (21 decks)

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