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Hyms year 2 > Block 10 week 1 > Flashcards

Block 10 week 1 Flashcards

1
Q

Autosomal Dominant Polycystic Kidney Disease

A
  • Is an example of a familial kidney disease.
  • 4th most common cause of pts on dialysis
  • caused by a genetic fault that disrupts the normal development of some of the cells in the kidneys and causes cysts to grow
  • symptoms: high blood pressure, headaches, abdominal pain and blood in the urine, excessive urination.
  • Faults in 1 of 2 different genes are known to cause AKPD.

-PKD1 mutation - more severe, earlier onset (30-40yr old)

  • PKD2 mutation - less sever, later onset (70 yr old)
  • 2 versions of polycystic kidney disease.
  • Autosomal dominant - presents in adulthood
  • Autosomal recessive - present in infancy or before birth

Diagnoses: ultrasound scanning and genetic screening

Treatment: surgery, medications to control symptoms.

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2
Q

Advantages vs Disadvantages of being screened for ADPKD

A
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3
Q

The approach to patient with kidney disease lecture

A
  • Kussmaul breathing - type of hyperventilation that is the lungs emergency response to acidosis
  • Kussmaul breathing - laboured deeper breathing
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4
Q

Amyloidoisis

A
  • rare disease when a protein called amyloid builds up in the organs.
  • The disorder involves the kidneys 80-90% of patients
  • There are amyloid deposits in the glomeruli.
  • The commonest presentation is proteinuria or the nephrotic syndrome
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5
Q

Stages for AKI and CKD

A

AKI has 3 types: prerenal, intrinsic and postrenal

AKI has 4 phases.
1. ONSET phase: Kidney injury occurs

  1. OLIGURIC (anuric phase): Urine output decreases from renal tubule damage
  2. DIURETIC phase: The kidneys try to heal and urine output increases, but tubule scarring and damage occurs.
  3. RECOVERY phase: tubular edema resolves and renal function improves.
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6
Q

Measuring renal function

A
  • changes in serum creatine.
    Creatine produced from muscle breakdown. If everything else about a person stays the same and you measure creatine levels 6 month’s apart and it changes. The change would be due to the kidneys function.
  • Glomerular Filtration Rate (GFR)
  • Estimated Glomerular Filtration Rate (eGFR)
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7
Q

Urine Tests

A

Basic: dipstick test, urine protein:creatine ratio

Special circumstances: urine culture, urine electrolytes, urine ‘stone screen’

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8
Q

Vescio-coli- fistula

A

-Abnormal connection that develops between the colon and bladder

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9
Q

Haematuria

A
  • painless blood in the urine is alarming and could indicate a cancer
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10
Q

Renal ultrasound imaging

A
  • First lien test in renal impairment
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11
Q

Plain CT

A
  • 1st line for suspected stones
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12
Q

Contrast enhanced CT

A

CT angiogram:
- Renal artery stenosis
- Suspected bleeds post renal biopsy

CT Venogram:
- renal vein thrombosis

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13
Q

RENAL ANGIOGRAM

A

Renal MR Angiogram

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14
Q

DMSA scan

A
  • Lets you know the relative function of each kidney separately unlike GFR which would give you the whole view.

-DMSA (dimercapto succinic acid) is a short-lived radioisotope that goes directly to the kidneys once inside the body and only stays radioactive for a few hours.

Overview:
- Ultrasound Scan first line for imaging

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15
Q

Treatment

A
  • Renal transplants have better patient outcomes and are more cost effective
  • The problem is the availability of organs
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16
Q

Dialysis

A

Two types:

  • Hemodialysis - patients visit hospital 3 times weekly. Stay on dialysis 4hrs each time
  • Peritoneal dialysis. Need to repeat 1-4 times a day
  • Peritoneal dialysis is a type of dialysis that uses the peritoneum in a person’s abdomen as the membrane through which fluid and dissolved substances are exchanged with the blood. It is used to remove excess fluid, correct electrolyte problems, and remove toxins in those with kidney failure.
  • Peritoneal dialysis can be done at home if patient is capable.
  • Assisted peritoneal dialysis. Nurse comes in and helps you change peritoneal dialysis
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17
Q

Advantages of dialysis

A
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18
Q

Disadvantages of dialysis

A
  • Patients have to be very careful with what they can eat or drink. Anything they eat between dialysis sessions remains in their system as kidneys are not functioning.
  • Employment difficulties - due to time needed for dialysis
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19
Q
A

Juxtaglomerular apparatus:
- Macula densa (DCT) - senses Na+ levels and responds by activating RAAS. Causes reabsorption of Na+ therefore reabsorption of water

  • Juxtaglomerular cells: secrete renin
  • Mesangial cells: remove debris
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20
Q

Anatomy

A
  • Right gonadal vein drains straight into the IVC
  • Left gonadal vein drains into the left renal vain which drains into the IVC
  • Something else you should know is the left renal vein is longer than the right renal vein
  • Nutcracker syndrome: compression of the left renal vein by the superior mesenteric artery. Presentation abdominal pian, hematuria, varicocele
  • Ureters run under the vas deferens and uterine artery and over the common iliac artery (water under the bridge).”Water under the bridge”; the ureter (carrying urine or “water”) traverses deep and inferior to (below) the uterine artery (the bridge).
  • Complications can occur during gynecologic procedures to uterine artery or vas deferens because it is so close to the ureters.
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21
Q
A
  • The detrusor muscle is a smooth muscle under autonomic control.
  • Parasympathetic innervation promotes bladder contraction and urination. it receives parasympathetic signaling via the pelvic splanchnic nerves (S2-S4).

-Sympathetic innervation promotes bladder relaxation and urine storage.

  • The internal urethral sphincter is under involuntary control, while the external urethral sphincter is under voluntary control.
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22
Q

Which of the following renal structures is most susceptible to ischemia?

A
  • Loop of henle
  • There are multiple factors that contribute to the loop of Henle’s susceptibility to ischemia.

-Active transport of sodium occurs at the ascending limb of the loop of Henle - this requires a great deal of energy and oxygen. During periods of hypoxia, the oxygen demand of the loop of Henle may be greater than the oxygen supply, leading to ischemia.

-In addition, structures deeper in the renal medulla are more susceptible to ischemia than the renal cortex because the medullary blood flow is kept low to facilitate reabsorption. The loop of Henle is located within the renal medulla.

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23
Q

Wilms tumor and Renal Cell Carcinoma

A
  • Wilms’ tumor is the most common cause of renal malignancy in infants; it results from the malignant overgrowth of the metanephric blastema.
  • Malignant overgrowth of the metanephric mesenchyme/blastema in childhood is categorized as a Wilms’ tumor, which is the most common cause of renal malignancy in infants.
  • Renal cell carcinoma is the most common cause of renal malignancy in adults; it originates from the proximal convoluted tubule.
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24
Q

Horseshoe kidney

A

-A horseshoe kidney is associated with the fusion of the inferior poles of the kidney leading to impaired renal ascension and is associated with genetic aneuploidies.

-A horseshoe kidney can be asymptomatic for life.

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25
Q

Multicycstic dysplastic kidney and renal agenesis

A

Renal agenesis describes the complete absence of one or both kidneys due to failure of the ureteric bud to develop - in most cases, the ureter will also be absent so a duplex collecting system would be highly unlikely.

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26
Q

Active vs passive transport

A
  • Active transport requires ATP
  • Passive transport does not require ATP. Make use of electrochemical gradients
  • co transport - molecules come in together
  • counter transport - one molecule in and another molecule out
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27
Q

Proximal convoluted tubule transporters

A
  • reabsorb 100% glucose by Na+/glucose cotransporter. SGLT2

-reabsorb H2CO3 (bicarbonate). H2CO3 is broken down into H20 and CO2 by carbonic anhydrase in the lumen of the PCT. They cross into the cell.

  • In the cell carbonic anhydrase joins H2O and CO2 back together into H2CO3.
  • H2CO3 can cross into the peritububular capillaries using a Na+/H2CO3 cotransporter.
  • PCT reabsorbs 60-70% off Na+, Cl-, PO43+, K+, HCO3-
  • Parathyroid hormone: phosphate trashing hormone. Decreases the function of the sodium phosphate transporter. So less phosphate is reabsorbed back into the blood and more is got rid of in urine
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28
Q

Angiotensin 2

A
  • Angiotensin II increases sodium reabsorption and decreases H+ reabsorption.
  • Angiotensin II increases the action of the Na+/H+ antiporter, thereby increasing sodium reabsorption and decreasing H+ reabsorption
  • Na+/H+ countertrasnporter
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29
Q

Fanconi syndrome

A

Fanconi syndrome is a defect in the proximal convoluted tubule (PCT) that impairs reabsorption. Large amounts of potassium excretion will result in hypokalemia.

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30
Q

Loop of Henle

A
  • Thin descending, thin ascending, thick ascending
  • Thin descending loop: passively reabsorbs H2O driven by medullary hypertonicity. Lots of Na+ in the medullary space. So water leaving loop.
  • Na+ cant leave the loop in the thin descending loop so the concertation of Na+ increases and is highest at the bottom of the loop of Henle

Thick Ascending loop:
- actively reabsorb Na+, Cl- and K+ through NKCC transporters down sodium concentration gradient.

  • Sodium to peritubular capillaries via 2K+/3Na+ countertransporter which uses ATP

Thick ascending loop: impermeable to H2O

  • Mg2+ and Ca2+ enter the cell then blood paracellularly. So they don’t go across the cell but around the cell.
31
Q

The NKCC transporter uses which type of transport?

A
  • Secondary active transport
32
Q

Which characteristic of the thin descending loop of Henle is responsible for the concentration of urine?

A
  • Impermeability to Na+ but permeable to H2O
33
Q

Which of the following is not reabsorbed in the thick ascending loop of Henle?

A
  • water
34
Q

Distal convoluted tubule

A
  • impermeable to H2O. Site of lowest osmolarity
  • Reabsorbs some Na+, Cl-, Mg2+ and Ca2+
  • PTH increases calcium reabsorption in the DCT.

Where is the renal filtrate most dilute ?

  • Distal convoluted tubule
35
Q
A
36
Q

Collecting Duct

A
  • Reabsorbs H2O, Na+, Urea
  • Secretes K+ and H+
  • Reabsorb: nephron to blood (back to body)
  • Secrete: blood to nephron ( urine)
  • Types of cells in collecting duct:
    principal cell, a-intercalated cell, b- intercalated cell

Principal cell: primary Na+ absorption

a-intercalated cell: secretes acid and reabsorbs bicarbonate

b-intercalated cell: secretes bicarbonates and reabsorbs acid

37
Q

Hormone effects

A

Aldosterone releases as part of RAAS causes reabsorption of Na+ so reabsorption of water

  • Aldosterone stimulates Na+/K+ pump
  • Also stimulates ENaC channel - brings Na+ into
    cell and pushes K+ out

ADH binds to V2 receptors will help increase water reabsorption.

38
Q

Steps when someone ahs a renal disease ?

A

Now when an individual is suspected of having renal disease, BUN and creatinine levels are checked and based on creatinine levels, the eGFR is calculated to assess renal function.

Additionally, urinalysis is done both by microscopy and dipstick, and a 24-hour protein collection is done as well.

Microscopy gives information about what the cells in the urine look like.

Now, the dipstick test is more of a qualitative and semiquantitative test- try saying that three times fast. It can give information about what’s in the urine- such as blood or proteins, but can’t exactly say how much of it there is.

That’s why a 24-hour protein collection is done in order to determine how much protein is lost through urine.

The 24 hour protein collection can show moderate proteinuria which is between 1 and 3.5 grams per day and this usually indicates nephritic syndrome or isolated proteinuria, or it can show severe proteinuria, which is greater than 3.5 grams per day and this is nephrotic syndrome range proteinuria.

An alternative to a 24-hour protein collection, is calculating the urine protein/creatinine ratio using spot urine samples. This is calculated by dividing the urine protein by the urine creatinine.

39
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40
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41
Q

Benign prostatic hyperplasia

A
  • BPH is the non-cancerous growth of the prostate gland
  • common in men over 50 and is considered a normal part of aging
  • urethra goes through prostate before reaching penis - prostatic urethra
  • During an ejaculation, sperm leave the testes, travel through the vas deferens, into the ejaculatory ducts, and travel through the prostatic urethra

-The basal cells and luminal cells of the prostate rely on stimulation from androgens, or male sex hormones, for survival.

  • The androgens include testosterone, which is produced by the testicles, and dihydrotestosterone, which is produced in the prostate itself.
  • This androgen is produced by the prostatic enzyme 5α-reductase which converts testosterone into the more potent dihydrotestosterone.

-Since androgens are steroids, so they can cross the cell membrane and bind to the androgen receptors within the cell’s nucleus.

  • Androgens inhibits the apoptosis of or programmed cell death, allowing luminal and basal cells in the prostate to keep growing and multiplying.

-Dihydrotestosterone is ten times more potent than testosterone because it can bind to androgen receptors much longer.

-Now, after the age of 30, men produce about 1% less testosterone per year.

  • But for unclear reasons, 5α-reductase activity increases with age, so even with less testosterone, there could be an increase in dihydrotestosterone.
  • Normal prostate cells respond to the increase in dihydrotestosterone levels by living longer and multiplying - that’s the underlying cause of benign prostatic hypertrophy.
42
Q
A

-This is a normal process of aging, and around 50% of men develop BPH by the age of 60, and over 90% have it by the age of 85.

-Fortunately, in BPH there’s no increased risk for developing cell mutations that lead to prostate cancer.

-Rather, the entire prostate gland enlarges pretty uniformly and small hyperplastic nodules can form within it.

-When these nodules or the prostate tissue itself compresses the prostatic urethra, it becomes more difficult for urine to pass though.

  • So the urine builds up in the bladder causing it to dilate.

In response, the smooth muscle walls of the bladder will contract harder, and this leads to bladder hypertrophy were the walls thicken and become irritable.

  • Finally, the stagnation of urine in the bladder also promotes bacterial growth, and can lead to urinary tract infections.
43
Q

Symptoms of BPH

A

Symptoms of BPH start up when the prostatic urethra gets obstructed, and it leads to a weak and inconsistent stream of urine, called dribbling.

The person might also have to strain when urinating to overcome the obstruction, have pain during urination called dysuria, or trouble initiating urination called hesitancy.

As urine builds up in the bladder it causes a constant sense of incomplete bladder emptying, which increases the frequency of urination at night - called nocturia.

44
Q

Diagnosis

A

Benign prostatic hyperplasia can be identified on physical examination with a digital rectal examination, which is where a finger, is inserted into the rectum to feel against the anterior wall of the rectum which lies along the posterior prostate.

An enlarged prostate could indicate benign prostatic hyperplasia, while hard nodules could be a sign of prostate cancer.

Levels of prostate specific antigen or PSA, a substance produced by healthy prostate cells, are also elevated in benign prostatic hyperplasia, since there are more cells around making the PSA.

45
Q
A

Treatment of BPH focuses on relieving the obstruction and allowing the urine to flow normally.

This can be done through medications like finasteride, a 5α-reductase inhibitor, which shrinks the prostate gland by inhibiting the conversion of testosterone into dihydrotestosterone.

Next, α1-antagonists like phenoxybenzamine can bind to α1 receptors on the smooth muscles in the neck of the bladder, the prostate, and urethra, causing them to relax and allowing urine to pass.

In some cases, surgical procedures like transurethral resection of the prostate, or TURP, can be done to remove part or all of the prostate.

Summary

46
Q

Discuss the need for a PSA result and the relevance of this to a screening program ?

A
  • Elevated PSA levels can indicate the presence of prostate cancer, but they can also be caused by non-cancerous conditions such as benign prostatic hyperplasia (BPH) or prostatitis. Therefore, a high PSA level doesn’t necessarily mean cancer, and further diagnostic tests are often needed

-PSA testing has limitations, including a risk of false positives and overdiagnosis. The decision to undergo PSA testing should involve informed discussions between patients and healthcare providers, weighing the potential benefits and risks.

  • Overdiagnosis refers to the detection of cancers that may not cause harm during a person’s lifetime. This can lead to unnecessary treatments with associated risks and side effects.
  • PSA levels can help stratify the risk of prostate cancer. Higher PSA levels may prompt further investigations, including biopsies, to confirm the presence of cancer.
  • The interpretation of PSA results is nuanced. Different factors, such as age, race, and family history, can affect what is considered a “normal” PSA level. It’s important to consider these factors when assessing the relevance of PSA results.
47
Q

Look at causes of pathology related to urinary symptoms and bladder overactivity ?

A
  • UTI (Urinary Tract Infections): infections of the urinary tract, particularly the bladder, can cause inflammation and irritation.

UTI symptoms: Frequent urination, urgency, burning sensation during urination, lower abdominal discomfort

  • Interstitial Cystitis (inflamed or irritated bladder wall) : can lead to scarring and stiffening of bladder. bladder cant hold as much urine. Chronic disorder.

Interstitial Cystitis symptoms: Urgency, frequency, pelvic pain or discomfort, nocturia.

  • Bladder Stones: Stones in the bladder can irritate the bladder lining and cause symptoms similar to UTIs.
    Symptoms: Frequency, urgency, pain or discomfort during urination
  • Overactive Bladder (OAB):

Pathology: Described as a syndrome, OAB involves detrusor muscle overactivity, leading to involuntary contractions and urinary urgency.
Symptoms: Urgency, frequency, nocturia, and sometimes incontinence.

-Neurogenic Bladder:

Pathology: Dysfunction of the nervous system (e.g., spinal cord injury, multiple sclerosis) can disrupt the normal coordination between the bladder and the external urethral sphincter.
Symptoms: Incontinence, urgency, difficulty initiating or stopping urination.

48
Q

Definition of sensitivity and specificity?

A

Sensitivity and specificity are terms commonly used in the field of diagnostic testing, particularly in medicine. They are statistical measures that assess the performance of a diagnostic test by evaluating its ability to correctly identify or exclude a condition of interest.

Sensitivity:

Definition: Sensitivity, also known as the true positive rate or recall, measures the proportion of actual positive cases correctly identified by a diagnostic test.
Formula: Sensitivity = True Positives / (True Positives + False Negatives)

Interpretation: A high sensitivity indicates that the test is good at identifying individuals who have the condition, minimizing the number of false negatives

Specificity:

Definition: Specificity measures the proportion of actual negative cases correctly identified by a diagnostic test.

Formula: Specificity = True Negatives / (True Negatives + False Positives)
Interpretation: A high specificity indicates that the test is good at correctly identifying individuals who do not have the condition, minimizing the number of false positives.

In summary:

Sensitivity is concerned with the ability of a test to correctly identify individuals with the condition (true positives).

Specificity is concerned with the ability of a test to correctly identify individuals without the condition (true negatives).

It’s important to note that there is often a trade-off between sensitivity and specificity. Increasing sensitivity may decrease specificity and vice versa. The choice between the two depends on the specific goals of the diagnostic test and the potential consequences of false positives and false negatives in a given context

49
Q

Lower Urinary Tract Infection

A

-Cystitis - inflammation of the bladder

-Now a urinary tract infection, or UTI, is any infection of the urinary tract, which includes the upper portion of the tract—the kidneys and ureters, and the lower portion of the tract—the bladder and urethra.

  • Lower UTIs are almost always caused by an ascending infection, where bacteria typically moves from the rectal area to the urethra and then migrate up the urethra and into the bladder.
  • Having said that, on rare occasions, a descending infection can happen as well where bacteria starts in the blood or lymph and then goes to the kidney and makes its way down to the bladder and urethra.
  • most of the time bacteria cant thrive in the bladder where there is urine. Some bacteria can survive the harsh conditions.
  • E. coli accounts for the vast majority of UTIs, also though, other gram negative bacteria that can infect the bladder include Klebsiella, Proteus, Enterobacter, and Citrobacter species.
  • On the other hand, gram positive bacteria can also cause problems, like Enterococcus species, and Staphylococcus saprophyticus, which is actually the second most common cause after E. coli and particularly affects young, sexually active women.
50
Q

Risk factors for UTI

A
  • sexual intercourse - bacteria introduced to urethra
  • women - shorter urethra
  • post-menopausal women - decrease in estrogen levels, which causes the normal protective vaginal flora to be lost increasing the risk of a UTI
  • presence of foley catheter - can introduce pathogens to urethra
  • diabetes mellitus - hyperglycemia - decreases neutrophils effectiveness, not good at destroying pathogens - remain - UTI
  • boys with foreskin - higher risk
  • impaired bladder emptying - urinary stasis- urine tends to sit sill in bladder - bacteria opportunity to colonize.
51
Q

SYMPTOMS OF LOWER UTI

A
  • Suprapubic pain - pain in lower abdomen
  • dysuria - painful when urinating
  • frequent urination and urgency - you have to go a lot and you have to go now
  • urine voids in small volume

Infants:
- fever
- fussy
-feed poorly

Elderly:
- fatigue
- incontinent
- delirium

Symptoms not usually present in lower UT!:
- adults systemic signs: fever, nausea, vomiting
- pain at the costovertebral angle (12th rib and vertebral column)

  • if present may indicate upper UTI
52
Q

Diagnosis

A

urinary analysis:
-pyuria - wbc in urine (cloudy urine)

Dipstick test:
-positive leukocyte esterase - enzyme created by leukocytes
- positive for nitrites - gram negative organisms like E.Coli convert nitrates in the urine to nitrite

  • urine culture gold standard for diagnosis
  • Now, if there is pyuria but the urine culture doesn’t reveal a bacteria, this is known as sterile pyuria, and it suggests urethritis, inflammation of just the urethra, as opposed to cystitis.
  • Isolated urethritis is most commonly caused by Neisseria gonorrhoeae and Chlamydia trachomatis, both of which are sexually transmitted infections.
53
Q

Cystometry

A
  • Cystometry, also known as flow cystometry, is a clinical diagnostic procedure used to evaluate bladder function
  • Specifically, it measures contractile force of the bladder when voiding.
54
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A
55
Q

Cytometry

A
56
Q
A
57
Q

Acute urinary retention

A

Acute urinary retention (AUR) is a medical emergency that occurs when an individual suddenly and completely loses the ability to urinate. This condition is often painful and requires prompt medical attention. A person experiencing acute urinary retention is typically unable to pass any urine despite having a strong urge to do so.

Common causes:
- BPH
- UTI
- Bladder stones
- Prostate infections or inflammation

58
Q

Bladder outflow obstruction

A

Bladder outflow obstruction refers to a condition where there is an impediment or blockage that hinders the normal flow of urine from the bladder to the urethra and out of the body. This obstruction can be caused by various factors and may lead to a range of symptoms and complications. Common causes of bladder outflow obstruction include:

  • BPH
  • Prostate cancer: Tumors in the prostate can also lead to blockage of the urethra, affecting the normal flow of urine.
  • Urethral Stricture: Narrowing of the urethra due to scar tissue or inflammation can cause obstruction.
59
Q
A

-Intermittent self-catheterisation (ISC): is used to treat bladders that do not empty fully.

  • you only use insert catheter in intervals during the day when you feel like you need to empty your bladder.
  • A health professional will teach you how to do this on your own

Indwelling urinary catheter: remains in the bladder.

-You may use an indwelling catheter for a short time or a long time. An indwelling catheter collects urine by attaching to a drainage bag. The bag has a valve that can be opened to allow urine to flow out.

Mitrofanoff catheterisable stoma:

  • The Mitrofanoff procedure creates a new tube on a child’s belly through which a child can urinate (pee) by using a catheter (putting a small tube into the new tube). The new tube is made from the appendix. It connects the bladder to a small hole created in the belly button or in an area in the lower belly. This way, children can empty their bladders by catheterizing through the new tube instead of using the urethra (the tube that pee normally goes through when it leaves the body).
60
Q
A
61
Q

TURP

A

TURP stands for Transurethral Resection of the Prostate, and it is a surgical procedure used to treat benign prostatic hyperplasia (BPH).

Procedure:

TURP is typically performed under general or spinal anesthesia.

During the procedure, a surgeon uses a specialized instrument called a resectoscope. The resectoscope is inserted into the urethra and then advanced through the prostate gland.

The resectoscope has a wire loop or electrode, which is used to remove small pieces of the enlarged prostate tissue. This process is known as transurethral resection.

OBJECTIVE:
- The primary goal of TURP is to remove the obstructing prostate tissue that is causing urinary symptoms. By doing so, it opens up the urinary channel and improves urine flow.

RECOVERY:
Recovery from TURP is generally faster than from open surgical procedures. Most patients spend a day or two in the hospital and can resume normal activities within a few weeks.
There may be some temporary side effects, such as blood in the urine and irritation during urination, but these usually resolve over time.

RISKS:
As with any surgical procedure, TURP has associated risks. These can include bleeding, infection, changes in sexual function (such as retrograde ejaculation), and, in rare cases, damage to surrounding structures.

62
Q

OPEN PROSTATECTOMY

A

An open prostatectomy is a surgical procedure performed to treat benign prostatic hyperplasia (BPH) or, in some cases, prostate cancer. Unlike transurethral procedures such as TURP (Transurethral Resection of the Prostate), an open prostatectomy involves making an incision in the lower abdomen to access and remove a portion of the prostate gland. This procedure is typically reserved for cases of very large prostates or when other treatments are not suitable.

PROCEDURE:
The surgery is performed under general or spinal anesthesia.
An incision is made in the lower abdomen, either vertically or horizontally, to expose the prostate gland.
The surgeon then removes the excess prostate tissue that is causing urinary obstruction.
After the removal of the prostate tissue, the surgeon closes the incision with stitches or staples.

RECOVERY:
Recovery from open prostatectomy is generally longer compared to less invasive procedures like TURP.
Hospital stay is typically a few days, and full recovery may take several weeks.
Patients may experience temporary side effects such as blood in the urine, urinary incontinence, and irritation during urination.

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DETRUSOR FAILURE (underactive detrusor function)

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  • Underactive detrusor function, also known as detrusor underactivity, refers to a condition in which the detrusor muscle in the bladder is weakened or contracts insufficiently during the voiding phase.

-The detrusor muscle is responsible for contracting and emptying the bladder, allowing for the proper elimination of urine. When this muscle does not function adequately, it can lead to difficulties in emptying the bladder and various urinary symptoms.

SYMPTOMS:
- difficulty emptying bladder
- weak urine stream (- inadequate detrusor muscle contraction

  • Increased post-void residual volume:
    After urination, there may be a larger than normal amount of urine left in the bladder, known as post-void residual volume.
  • Hesitancy
  • Frequency and Urgency -

Despite difficulty emptying the bladder, individuals may experience a frequent urge to urinate.

Underactive detrusor function can be caused by various factors, including aging, neurological conditions, pelvic surgery, or damage to the nerves controlling the bladder. It is important to note that this condition is distinct from overactive bladder (OAB), where the detrusor muscle contracts too frequently, leading to symptoms such as urgency, frequency, and incontinence.

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INCONTINENCE

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  • involuntary loss of urine
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Overactive bladder

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Overactive bladder (OAB) is a medical condition characterized by a group of urinary symptoms that result from involuntary contractions of the bladder muscle. The key symptoms associated with overactive bladder include urgency, frequency, and sometimes urge incontinene

Overactive bladder (OAB) is a medical condition characterized by a group of urinary symptoms that result from involuntary contractions of the bladder muscle. The key symptoms associated with overactive bladder include urgency, frequency, and sometimes urge incontinence. OAB can significantly impact an individual’s quality of life and daily activities.

Here are the main features of overactive bladder:

Urgency:

Urgency refers to a sudden and strong need to urinate that is difficult to control. It may be accompanied by a fear of leakage if a restroom is not reached quickly.
Frequency:

Frequency is the need to urinate more often than usual. In some cases, individuals with OAB may need to urinate every couple of hours, or even more frequently.
Urge Incontinence:

Urge incontinence is the involuntary loss of urine associated with a strong urge to urinate. It can result in leakage before reaching the restroom.

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