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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
Q

What is a cystoscopy?

A

a thin tube with a camrea is inserted through the urethra

LA administered

26
Q

What is photoselective vaporisation?

A

cystoscope inserted into prostatic urethra

laser destroys obstructive tissue

27
Q

Why might alpha reductase inhibitors be used to treat benign prostate enlargement?

A

they prevent the conversion of testosterone to DHT

DHT causes prostatic hyperplasia

28
Q

Which part of the prostate is the bit which enlarges?

A

transitional zone

29
Q

What is the best way to test for benign prostate enlargement?

A

digital rectal examination

30
Q

How might a digital rectal examination help differentiate between cancerous / no cancerous enlargement?

A

hard nodule - cancer
soft protrusion - BPH

not always tho so watch out xxx

31
Q

What are the two main sites for spongy urethral tear?

A

inferior to urogenital diaphragm

superior to urogenital diaphragm

32
Q

What might cause a spongy urethral tear inferior to the urogenital diaphragm?

A

straddle injuries

33
Q

Which is more common:
partial disruption of the anterior urethra
complete tear?

A

partial disruption

34
Q

How may classifications of urethral ruptures superior to the urogenital diaphragm are there?

A

5

35
Q

What is type I superior rupture?

A

stretching of posterior urethra

36
Q

What is type II rupture?

A

posterior urethral injury above urogenital triangle

37
Q

What is type III rupture?

A

injury to membranous urethra

38
Q

What is type IV rupture?

A

bladder base injury involving bladder neck to proximal urethra

39
Q

What is type IVa rupture?

A

bladder base injury, not involving bladder neck

40
Q

What is type V rupture?

A

anterior urethral injury

41
Q

When would you treat and anterior urethral injury?

A

immediately after diagnosis

42
Q

How would you treat anterior urethral injuries?

A

bladder catheter 14-21 days

X -ray to check healing

43
Q

When would you treat a posterior urethral injury?

A

not quickly, associated with other injuries

44
Q

How would you treat a posterior urethral injury?

A

catheter in place for 3-6 months
wait for boddy to resorb swelling from pelvic fracture

surgery to reconstruct urethra

45
Q

What might cause type I urethral injury?

A

rupture of puboprostatic ligament

46
Q

What does type II urethral injury cause?

A

extraperitoneal extravasation of urine with retropubic space of REtzius

47
Q

What does type II urethral injury cause?

A

extraperitoneal extravasation of urine

urine does not extend into the thigh or anal triangle

48
Q

What does type IV urethral injury cause?

A

extraperitoneal extravasation of urine within retropubic space of Retzius

49
Q

What does a suprapubic catheter pass through?

A

skin
subcutaneous tissue
rectus fascia
preperitoneal space

50
Q

What allows a suprapubic catheter entry into the bladder?

A

cystostomy

51
Q

What are CAUI?

A

catheterisation-associated urethral injury

52
Q

What structures are at risk with CAUI?

A 
urethra
prostate
bladder
pelvic floow
corpus spongiosum of penis
53
Q

What structures are at risk with a suprapubic catheter?

A 
bowel
abdominal contents (rare)
external iliac injury
54
Q

What sorts of patients are at greater risk of external iliac injuries in suprapubic catheterisation?

A

obese patients

55
Q

What urinary function would be lost in damage to T12-L2?

A

sympathetic control of micturition (innervation of detrusor and IUS)

56
Q

What urinary function would be lost in damage to S2-S4?

A

parasympathetic control of detrusor

pudendal nerve responsible for EUS damaged

57
Q

What symptoms would be associated with S2-S4 damage?

A 
overlfow incontinence
straining in urination
inability to empty a full bladder
urinary infections
pain / burning in urination
blood in urine
lower abdo pain
58
Q

What symptoms might be associated with T12-L2 damage?

A

urinary incontinence
rashes / sores (skin is wet)
UTI symptoms
nocturia

3 REN (21 decks)

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