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RDS Test 3 > B8.041 The Bladder and Prostate > Flashcards

B8.041 The Bladder and Prostate Flashcards

1
Q

what is the ureter

A

25-30 cm muscular tubes tubes that undergo peristalsis

carry urine from renal pelvis to the bladder

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2
Q

are the ureters intra or retroperitoneal

A

retroperitoneal

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3
Q

where do the ureters enter the pelvis

A

cross the pelvic brim near the bifurcation of the common iliac into external and internal arteries

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4
Q

how do the ureters enter the bladder

A

on the posterolateral surface
enter at an oblique angle
junction = ureterovesicular junction

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5
Q

function of oblique pathways of ureter through bladder wall

A

natural one way valve

-lets urine into the bladder but doesn’t transfer pressure (or urine) back up the ureters

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6
Q

positioning of the ureters relative to male structures

A

run under and lateral to the ductus deferens at the bladder junction (water under the bridge)

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7
Q

movement of kidneys and testes during development

A

metanephric kidney rises to posterior abdominal wall while the testis drops into the scrotum

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8
Q

positioning of the ureters relative to female structures

A

pass inferior to the uterine artery but superior to the vaginal arteries
-important bc uterine artery is often clamped during hysterectomies, have to be careful not to damage the ureter

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9
Q

common sites of ureter damage

A
  1. pelvic brim (where it crosses the common iliac)
  2. beneath uterine artery
  3. near ureterovesicular junction
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10
Q

what are kidney stones (renal calculi)

A

can be released from kidney and lodge and disrupt urine flow

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11
Q

common sites for stones to get stuck

A
  1. ureteropelvic junction
  2. as ureters cross pelvic brim
  3. ureterovesicular junction (where ureters pass into bladder)
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12
Q

treatment of kidney stones

A

may be dislodged by increased fluid intake
invasive option: cystoscope and ureteroscope used to endoscopically grasp or break up the stone
increasingly, smooth muscle relaxants are being used (tamsulosin)

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13
Q

epidemiology of duplication of ureters

A 
most common renal abnormality
occurs in 1% of the population
found in 8% of children with recurrent UTIs
more common in caucasians
more common in females
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14
Q

pathophys of duplicated ureters

A

ureteric bud either splits or arises twice

in most cases, kidney is divided into two parts (upper and lower lobe) with some intermingling

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15
Q

bifid ureter

A

slips between bladder and kidney

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16
Q

bladder relationship

A

lies under the peritoneal membrane

-extraperitoneal

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17
Q

bladder location

A

anteriorly - symphysis pubis
posteriorly - rectum in males, and the uterus and part of the vagina in females
inferiorly - prostate in males, pelvic diaphragm in females

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18
Q

newborn bladder

A

fusiform in shape

extends in abdominal cavity up into the umbilicus

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19
Q

movement of bladder in childhood

A

by age 6, generally the bladder is located in the greater pelvis
as bladder recedes into the greater pelvis, it leaves behind the median umbilical fold over the urachus conncted to the umbilicus
by puberty, empty bladder lies in the true pelvis

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20
Q

exstrophy of the bladder

A

failure of abdominal wall closure during fetal development
protrusion of the anterior portion of the bladder wall through the lower abdominal wall
cover with film and irrigate with diaper changes until surgery can be performed

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21
Q

what is AFP

A

glycoprotein produced by the yolk sac, allantois, and the liver during fetal development
fetal form of albumin

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22
Q

function of AFP

A

measured in pregnant women through the analysis of maternal blood or amniotic fluid
screens for a subset of developmental abnormalities
“triple screen” at 16-19 wks

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23
Q

conditions with elevated AFP

A 
omphalocele
gastroschisis
HCC
neural tube defects
nonseminomatous germ cell tumors
youlk sac tumor
exstrophy of the bladder
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24
Q

pathophys of patent urachus

A

on rare occasion, the urachus can re-canalize (in infants or the elderly) leading to a dribbling of urine from the umbilicus
(20% of urachal anomalies)

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25
Q

urachal cyst

A

small fluid filled cyst superior to the bladder and inferior to the umbilicus
(43% of urachal anomalies)

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26
Q

urachal sinus

A

remnant of the urachus that connects to the umbilicus

35% of urachal anomalies

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27
Q

urachal diverticulum

A

develops off the apex of the bladder
typically goes unnoticed
(2% of urachal anomalies)

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28
Q

symptoms of urachal fistula

A

leaking of urine and periumbilical inflammation

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29
Q

typical progression of the urachus

A

usually seals off and obliterates around the 12th week of gestation and all that is left is a small fibrous cord between the bladder and umbilicus called the median umbilical ligament

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30
Q

epidemiology of urachal defects in general

A

1-1.6% of population

males more frequent

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31
Q

symptoms of persistent urachal anomalies

A

continuous bladder and urine drainage around the umbilicus
recurrent UTI
urachal carcinoma (rare)

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32
Q

how to treat urachal defects

A

surgical resection

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33
Q

describe the anatomy of the bladder

A

smooth muscular vessel

inner surface of the mucosa is thrown into folds, rugae, except for the trigone

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34
Q

detrusor

A

smooth muscle of the wall of the bladder

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35
Q

trigone

A

triangular area between the two ureters opening and the internal urethral opening

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36
Q

innervation of detrusor

A

predominantly parasympathetic
causes contraction of the bladder wall, thus increasing internal pressure and causing micturation if the urethral sphincters are open

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37
Q

space of Retzius

A

retropubic space between pubic symphysis and bladder

normally filled with loose connective tissue

38
Q

how is the internal urethral sphincter kept closed

A

smooth muscle fibers and elastic fibers

closed it bladder has less than 250 mL of urine

39
Q

parasympathetic innervation of bladder

A

S2,3,4
pelvic splanchnic nerves
innervate mainly the detrusor muscle via inferior hypogastric plexus
some innervation of internal urethral sphincter

40
Q

sympathetic innervation of bladder

A

T11, L1,2
vesicle nerve plexus
innervates mainly the internal urethral sphincter via superior hypogastric plexus

41
Q

bladder contraction

A

parasympathetic

42
Q

bladder retention

A

sympathetic

43
Q

purpose of sympathetic discharge at emission/ejaculation

A

prevents retroejaculation of semen into the bladder

44
Q

function of internal urethral sphincter

A

keeps urine in bladder
prevents retroejaculation in males
sympathetic system maintains tonic contractions
parasympathetics relax muscle during micturation

45
Q

external urethral sphincter

A

under learned, voluntary control
formed by compressor urethra muscle (both males and females) and urethrovaginal sphincter muscle (females only)
innervated by pudendal nerve (somatic)

46
Q

sphincter innervation

A 
internal = sympathetic (a lil para)
external = pudendal (voluntary)
47
Q

paruresis

A

inability to urinate in the presence of others

due to sympathetic discharge causing closure of internal urethral sphincter

48
Q

when do adults feel bladder fullnes

A

300 mL of urine

stretch receptors appear to return information via sym and para pathways (para most important) as the bladder fills

49
Q

what initiates the feeling of bladder fullness

A

stretch receptors stimulate a spinal reflex arch, causing parasympathetic nerve firing, leading to contraction of the wall of the bladder
this causes urination if the bladder wall contraction is sufficiently strong to open the internal urethral sphincter

50
Q

potty training

A

learning to override the reflex to keep sphincters, especially the external sphincter, closed against periodic contractions of the detrusor

51
Q

prevalence of incontinence

A

77% of incontinent patients are women

88% of all incontinent patients have stress incontinence

52
Q

stress incontinence

A

problem with the closing mechanism of the urinary tract outlet (urethral sphincter most important)

53
Q

result of stress incontinence

A

involuntary leakage while sneezing, coughing, laughing, or lifting heavy weights

54
Q

epidemiology of stress incontinence

A

common in women, esp following childbirth

55
Q

treatment of stress incontinence

A

Kegels
estrogen
a agonists

56
Q

use of a agonists in stress incontinence

A

increase contractions of the smooth muscle at the neck of the bladder
help increase sphincter strength and may improve symptoms

57
Q

MMK procedure for stress incontinence

A

bladder neck suspension

adds support to bladder neck and urethra, reducing the risk of stress incontinence

58
Q

urge incontinence

A

need to urinate more than 7x a day or 2x at night
common in older adults
treatment: anticholinergics to inhibit parasympathetic stimulation of the detrusor muscle contractions

59
Q

solifenacin

A

competitive muscarinic subtype 3 ACh receptor antagonist
reduced smooth muscle tone in the bladder, allowing the bladder to retain larger volumes of urine, thus reducing number of bladder contractions, urgency, and incontinent episodes

60
Q

overflow incontinence

A

in patients who’s bladder no longer contracts properly, thus have a constantly full bladder and tend to constantly dribble
catheterization may help

61
Q

who gets overflow incontinence

A

diabetics who lost autonomic innervation to the bladder
males who suffer BPH
blockage of urethra with a kidney or bladder stone

62
Q

a-1 adrenergic blockers in overflow incontinence

A

relax smooth muscle contraction within the prostate to reduce prostatic urethral resistance

63
Q

bethanechol in overflow incontinence

A

parasympathomimetic choline ester that selectively stimulates muscarinic receptors without any effect on nicotinic receptors
longer duration of action than ACh bc not broken down by cholinesterase
stimulate smooth muscle contractions

64
Q

automatic reflex bladder

A

bladder response of an infant

seen in those w spinal cord damage > complete transection of the spinal cord above the sacral segments

65
Q

ureter pain

A

carried in a general visceral afferent that returns to the spinal cord along sympathetic nerve to T11-L1
usually referred to the ipsilateral lower quadrant of the abdomen, esp to groin/external genitalia

66
Q

male bladder blood supply

A

superior vesicle arteries: off medial umbilical artery (branch of internal iliac)
inferior vesicular arteries: supply fundus and neck

67
Q

female bladder blood supply

A

superior vesicle arteries: off medial umbilical artery (branch of internal iliac)
vaginal arteries: supply lower portion

68
Q

vesicouterine pouch

A

peritoneal space between bladder and uterus

69
Q

rectouterine pouch (of Douglas)

A

peritoneal space behind the uterine/vaginal junction and anterior to the rectum
lowest point in pelvic cavity in females

70
Q

retrovesical fossa

A

peritoneal space between the bladder and the rectum

lowest point in pelvic cavity in males

71
Q

paravesical fossa

A

peritoneal reflection on each side of the bladder (only present when bladder is distended)

72
Q

pararectal fossa

A

peritoneal reflection on each side of the rectum

73
Q

vas deferens course

A

35 cm long, 3 mm in diameter

  1. begins at the tail of the epididymis
  2. ascends the spermatic cord
  3. passes through inguinal canal
  4. crosses the external iliac vessels
  5. passes along the lateral pelvic wall before moving medially, stays extraperitoneal
  6. widens into an ampulla which lies just superior to the seminal vesicles
  7. joins the seminal vesicle ducts to form the common ejaculatory ducts
74
Q

vasovasectomy

A

reversal of vasectomy
reanastomosis and opening of cut and sealed vasal ends
pregnancy rates lower than expected, likely due to antisperm antibodies which develop with increased frequency since time of vasectomy

75
Q

seminal vesicles positioning

A

posterior to fundus of the bladder and anterior to the rectum, superior to the prostate
help form ejaculatory ducts
lie inferior to ampulla of vas deferens

76
Q

function of seminal vesicles

A

secrete 2 mL of viscous, slightly yellow fluid which is present in highest concentration in last half of the ejaculate
help wash sperm out of the urethra

77
Q

what is in the seminal vesicle secretion

A
  1. fructose
  2. prostaglandins (stimulate smooth muscle contraction in female repro tract to aid in sperm transport)
  3. proteins responsible for semen coagulation
  4. ascorbic acid
78
Q

prostate gland

A

exocrine gland below bladder
does not contain a true organ connective tissue around it
branching tubular alveolar glands embedded in fibromuscular connective tissue

79
Q

function of prostate

A

secretes 0.5 mL of thin, opalescent fluid in first portion of ejaculate

80
Q

components of prostate secretion

A

PAP
PSA
spermine
fibrinolysin

81
Q

prostatic acid phosphatase

A

may enhance the infectivity of HIV in semen

82
Q

prostate specific antigen

A

serine protease responsible for liquefaction of semen upon standin and liquefaction of cervical mucus
produced by both normal and malignant cells

83
Q

spemrine

A

oxidation responsible for musk odor of semen

antibacterial properties

84
Q

fibrinolysin

A

responsible for liquefaction of semen (with PSA)

85
Q

where do sperm and seminal vesicle secretions enter the urethra

A

within the prostatic urethra

between internal urethral sphincter and external urethral sphincter

86
Q

zones of prostate

A

transition (5%)
central (25%)
peripheral (70%)
periurethral (small)

87
Q

periurethral zone (+transitional)

A

mucosal gland, smallest region
lies immediately around urethra
resistant to inflammation and carcinoma, but the site of BPH

88
Q

peripheral zone

A

70% of prostate

site of prostate cancer

89
Q

what does prostate cancer feel like

A

local bump or lump

90
Q

what does BPH feel like

A

general enlargement of the gland

RDS Test 3 (15 decks)

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