AP03 Urinary Continence Flashcards
name 5 types of urinary incontinence
stress urge overflow functional mixed
Which ligaments support the area surrounding the neck of the bladder?
lateral and medial puboprostatic ligaments
lateral ligament
posterior ligament
What is a cystocoele?
a prolapsed bladder, where it bulges into the vagina
How would you treat a cystocoele?
activity changes kegel exercises surgery HRT Pessary
What is a pessary?
a device to support the structure of the vagina
What stimulates parasympathetic bladder control?
afferent of full bladder
What nerve is involved in parasympathetic bladder control??
Pelvic nerve
Where does the pelvic nerve originate from?
S2-4
Where are the pelvic nerve parasympathetic ganglia?
bladder wall
What does parasympathetic innervation of the bladder stimulate?
muscle contraction and bladder emptying
What is the sympathetic afferent of the bladder stimulated by?
urine increasing bladder pressure
What nerve mediates sympathetic control of the bladder?
Hypogastric nerve
Where does the hypogastric nerve originate from?
T10-L2
What does sympathetic innervation of the bladder stimulate?
IUS contraction
bladder filling
What mediates somatic control of the bladder?
Pudendal nerve
Where does the pudendal nerve originate from?
S2-4
What muscles does the pudendal nerve supply?
bulbospongiosus
ischiocavernosus
Levator Ani
EUS
By what age is the bladder stretch reflex developed?
3-5 years olf
What does it mean to be enuretic?
you fail to develop voluntary control over urination
How might a stroke cause functional incontinence?
lower limbs less active so can’t get to the toilet in time
How might a stroke cause pontine incontinence?
damage to the pons inhibits the action of the pontine urinary centre
inability to store urine
What happens in damage to the pontine continence centre?
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
Do mild symptoms of benign prostate enlargement need treatment?
nope
What is AUR?
What should you do?
acute urinary retention
A and E quick time
What is a cystoscopy?
a thin tube with a camrea is inserted through the urethra
LA administered
What is photoselective vaporisation?
cystoscope inserted into prostatic urethra
laser destroys obstructive tissue
Why might alpha reductase inhibitors be used to treat benign prostate enlargement?
they prevent the conversion of testosterone to DHT
DHT causes prostatic hyperplasia
Which part of the prostate is the bit which enlarges?
transitional zone
What is the best way to test for benign prostate enlargement?
digital rectal examination
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
What are the two main sites for spongy urethral tear?
inferior to urogenital diaphragm
superior to urogenital diaphragm
What might cause a spongy urethral tear inferior to the urogenital diaphragm?
straddle injuries
Which is more common:
partial disruption of the anterior urethra
complete tear?
partial disruption
How may classifications of urethral ruptures superior to the urogenital diaphragm are there?
5
What is type I superior rupture?
stretching of posterior urethra
What is type II rupture?
posterior urethral injury above urogenital triangle
What is type III rupture?
injury to membranous urethra
What is type IV rupture?
bladder base injury involving bladder neck to proximal urethra
What is type IVa rupture?
bladder base injury, not involving bladder neck
What is type V rupture?
anterior urethral injury
When would you treat and anterior urethral injury?
immediately after diagnosis
How would you treat anterior urethral injuries?
bladder catheter 14-21 days
X -ray to check healing
When would you treat a posterior urethral injury?
not quickly, associated with other injuries
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
What might cause type I urethral injury?
rupture of puboprostatic ligament
What does type II urethral injury cause?
extraperitoneal extravasation of urine with retropubic space of REtzius
What does type II urethral injury cause?
extraperitoneal extravasation of urine
urine does not extend into the thigh or anal triangle
What does type IV urethral injury cause?
extraperitoneal extravasation of urine within retropubic space of Retzius
What does a suprapubic catheter pass through?
skin
subcutaneous tissue
rectus fascia
preperitoneal space
What allows a suprapubic catheter entry into the bladder?
cystostomy
What are CAUI?
catheterisation-associated urethral injury
What structures are at risk with CAUI?
urethra prostate bladder pelvic floow corpus spongiosum of penis
What structures are at risk with a suprapubic catheter?
bowel abdominal contents (rare) external iliac injury
What sorts of patients are at greater risk of external iliac injuries in suprapubic catheterisation?
obese patients
What urinary function would be lost in damage to T12-L2?
sympathetic control of micturition (innervation of detrusor and IUS)
What urinary function would be lost in damage to S2-S4?
parasympathetic control of detrusor
pudendal nerve responsible for EUS damaged
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
What symptoms might be associated with T12-L2 damage?
urinary incontinence
rashes / sores (skin is wet)
UTI symptoms
nocturia
