ED + Incontinence

Question 0

What are the 4 types of incontinence?

Answer 0

U o SheField

Urge, overflow, stress, functional

Question 1

In urine storage what contracts and what relaxes?

In urine emptying what contracts and what relaxes?

Answer 1

Storage:
detrusor relax = symp
Internal sphincter = contract

Emptying:
Detrusor contract = PS
internal sphincter = relax

Question 2

Explain urge incontinence.

Answer 2

Atrophic urethritis, BPH, infection – >
Over activity of detrusor muscle –>
make low vol of urine –>

increased Frequency of urination
increased Urgency
Nocturia
Small volume voids i.e. less empty space

Question 3

Explain overflow incontinence

Answer 3

(Autonomic neuropathy – >detrusor inactivity
Outflow obstruction = BPH)
–>
Overflow incontinence –> dribbling + ⬇️urine flow

Alpha-adrenergic blockers to relax SM @ bladder neck

Cholinergic drugs = increase detrusor contraction

Question 4

Explain stress incontinence

Answer 4

@Women

Can’t maintain
90 – 100 degree posterior urethrovesical angle
+
decreased oestrogen – >

Increased laxity of pelvic floor muscles +
lack of bladder support – >

Lose urine @ increased intra-abdominal pressure i.e. laugh cough sneeze

– Oestrogen therapy
– Kegel pelvic floor exercises
– alpha adrenergics = contract SM @Bladder neck

Question 5

Explain functional incontinence

Answer 5

Cannot reach toilet in time =

diuretics/caffeinated beverages

Question 6

What are the cause erectile dysfunction

Answer 6

PE N DVT

Psychogenic, endocrine, neurological, drugs, vascular insufficiency, testosterone decrease

Question 7

Explain the psychogenic cause of erectile dysfunction

Answer 7

Stress + performance anxiety

Nocturnal penile tumescence is fine =
5 erections @ sleep

Question 8

Explain the endocrine cause of erectile dysfunction

Answer 8

Diabetes mellitus = autonomic neuropathy + vascular insufficiency

Primary hypo thyroidism = increased prolactin
– > decreased GnRH

Prolactinoma prolactin inhibits GnRH

Question 9

Explain the neuro cause of erectile dysfunction

Answer 9

Multiple Sclerosis, prostatectomy,

Diabetes mellitus automata neuropathy

Question 10

Drugs that cause erectile dysfunction

Answer 10

Leuprolide – GnRH agonist
Methyldopa
Psychotropics

Question 11

Vascular problems in terms of erectile dysfunction?

Answer 11

Most common + >50

Leriche syndrome

Aortoiliac atherosclerosis + decreased Penal bloodflow – >impotence

Question 12

Explain how testosterone relates to erectile dysfunction

Answer 12

Decreased testosterone – >decreased libido

Question 13

Explain how Viagra works

Answer 13

Sildenafil inhibits phosphodiesterase 5 –>
prevents breakdown of cGMP – >
SM can continue to relax –> therefore vasodilate
–> erect @corpus carvernosim