Female Lower Urinary Tract

Question 1

What is the detrusor muscle?

Answer 1

The smooth muscle wall of the bladder

Question 2

Capacity of the bladder?

Answer 2

500ml

Question 3

When do you first feel the urge to void (ml)?

Answer 3

200ml

Question 4

Which types of nerves aid voiding?

Answer 4

Parasympathetic

Question 5

Which types of nerves prevent voiding?

Answer 5

Sympathetic

Question 6

What is the voiding reflex?

Answer 6

Afferent fibres respond to bladder wall distension and pass to spinal cord
Efferent parasympathetic fibres pass back to the detrusor muscle and cause contraction and enable opening of bladder neck
Efferent sympathetic fibres to the detrusor are inhibited

Question 7

At what level is the ‘micturition reflex’ controlled?

Answer 7

The pons

Question 8

What is continence dependent on?

Answer 8

The pressure in the urethra being greater than that in the bladder

Question 9

What influences bladder pressure?

Answer 9

Detrusor pressure and intra-abdominal pressure

Question 10

What influences urethral pressure?

Answer 10

Inherent urethral muscle tone
External pressure (pelvic floor)
Intra-abdominal pressure

Question 11

Does bladder pressure increase as it fills?

Answer 11

No because the detrusor muscle expands

Question 12

Why does coughing not normally cause incontinence?

Answer 12

Coughing increases abdominal pressure but transmits it equally to the bladder and upper urethra because both lie within the abdomen

Question 13

When does micturition occur?

Answer 13

When bladder pressure exceeds urethral pressure

Question 14

How is micturition achieved?

Answer 14

Voluntarily by a simultaneous drop in urethral pressure (partly due to pelvic floor relaxation) and an increase in bladder pressure due to detrusor muscle contraction

Question 15

What are the 2 causes of female incontinence?

Answer 15

Uncontrolled increases in detrusor pressure increasing bladder pressure beyond that of the normal urethra

Increased intra-abdominal pressure transmitted to the bladder but not the urethra, because the upper urethra neck has slipped from the abdomen

Question 16

What is the most common cause of uncontrolled increases in detrusor pressure?

Answer 16

‘Overactive bladder’ (OAB) or urinary urge incontinence

Question 17

Most common cause of increased intra-abdominal pressure?

Answer 17

Urinary stress incontinence

Question 18

Urinary incontinence definition?

Answer 18

Involuntary urine leakage, which can be divided broadly into stress incontinence and urge incontinence

Question 19

Daytime frequency definition?

Answer 19

Number of times a woman voids during waking hours. Normally between 4 to 7. Increased daytime frequency is defined as occurring when a patient perceives that she voids too often by day

Question 20

Nocturia definition?

Answer 20

Waking at night one or more times to void. Up to the age of 70 years, more than 1 void is considered abnormal

Question 21

Nocturnal enuresis definition?

Answer 21

Urinary incontinence occurring at night

Question 22

Urgency definition?

Answer 22

Sudden compelling desire to pass urine, which is difficult to defer. Most frequently secondary to detrusor overactivity, although inflammatory bladder conditions such as cystitis may present with this

Question 23

Where is bladder pain felt?

Answer 23

Suprapubically or retropubically

Question 24

When does bladder pain typically occur?

Answer 24

Occurs with bladder filling and is relieved by emptying

Question 25

What is bladder pain indicative of?

Answer 25

Intravesical pathology e.g. interstitial cystitis or malignancy

Question 26

Urethral pain is felt where?

Answer 26

The urethra

Question 27

Dysuria definition?

Answer 27

Pain experienced in the bladder or urethra on passing urine, frequently associated with UTIs

Question 28

Haematuria definition?

Answer 28

Presence of blood in the urine. EIther microscopic or macroscopic (frank)
Always significant and warrants further Ix

Question 29

Ix of the urinary tract?

Answer 29

Urine dipstick tests
Urinary diary
Postmicturition US or catheterisation
Urodynamic studies, cystometry
Ultrasound
Abdominal x-rays
CT urogram
Methylene dye test
Cystoscopy

Question 30

What do urine dips test for?

Answer 30

Blood, glucose, protein leucocytes, nitrites

Question 31

What do nitrites in urine indicate and what should be done?

Answer 31

Presence of infection; send urine sample to microscopy and culture

Question 32

What does glycosuria suggest?

Answer 32

Diabetes

Question 33

What does haematuria suggest?

Answer 33

Bladder carcinoma or calculi

Question 34

What do postmicturition US or catheterisation do?

Answer 34

Exclude chronic retention of urine

Question 35

What are Urodynamic studies, cystometry?

Answer 35

Necessary prior to surgery for stress incontinence or for women whose overactive bladder Sx do not respond to medical therapy
Cystometry directly measures, via a catheter, the bladder (vesical) pressure whilst bladder is filled and provoked with coughing. Pressure transducer is also placed in rectum (or vagina) to measure abdo pressure

Question 36

What does US exclude?

Answer 36

Incomplete bladder emptying, checks for congenital abnormalities, calculi (solid particles in urinary system) and tumours and detects cortical scarring of kidneys

Question 37

What does abdo x-ray diagnose?

Answer 37

Foreign bodies and calculi

Question 38

What does CT test?

Answer 38

Using contrast, integrity and route of ureter are examined

Question 39

What does methylene dye test test?

Answer 39

Blue dye is inserted into bladder. Leakage from places other than the urethra e.g. fistulae can be seen

Question 40

What does cystoscopy exclude?

Answer 40

Tumours
Stones
Fistulae
Interstitial cystitis
BUT gives no indication of bladder performance