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Genitourinary 2 Flashcards

1
Q

Micturition

A

voiding or bladder emptying

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2
Q

Micturition requires the interplay of

A

nerves, detrusor muscle of the bladder, internal urethral sphincter (involuntary) and external urethral sphincter (voluntary, PV)

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3
Q

Neural control of lower urinary tract

A

During storage, the sympathetic system keeps the bladder relaxed, and the external sphincter is contracted.

During micturition, the parasympathetic system contracts the bladder, while the external sphincter is voluntarily relaxed.

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4
Q

Urinary or Fecal incontinence and pelvic organ prolapse are characteristics of overactive or underactive PFM?

A

underactive - your muscles cant keep them inside!

absent or weak contractions

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5
Q

Obstructive voiding or defecation, dyspareunia (painful intercourse), pelvic pain are associated with over or under active PFM?

A

overactive

cant voluntarily relax PFM

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6
Q

Only __-__% of incontinent adults eek medical care

A

20-50

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7
Q

Urinary incontinence contributes to what conditions?

A

falls
pressure sores
skin breakdown
UTIs
institutionalization
depression
isolation

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8
Q

Many people have more than one type of incontinence, most often which two together?

A

SUI
UUI

known as mixed UI

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9
Q

Stress Urinary Incontinence (SUI)

A

involuntary loss of urine on effort or physical exertion or on sneezing or coughing

occurs during activities that increase intrabdominal pressure

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10
Q

What causes stress incontinence?

A

weakness or loss of time in PFM

internal urethral sphincter failure

hypermobility of ureterovesical junction

damage to the pudendal nerve

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11
Q

Urgency Urinary incontinence (UUI) - what is it and what is is usually due to?

A

sudden compelling desire to urinate that is difficult to defer

often related to the detrusor (bladder) muscle contracting at small volumes

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12
Q

Which urinary incontinence occurs in response to triggers like running water or arriving home?

A

UUI

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13
Q

Other types of incontence

A

overactive bladder
functional (cant get up to go)
overflow
transient (temporary loss of control)

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14
Q

Some risk factors for urinary incontinence

A

high impact exercise
hormonal changes (estrogen deficiency)
SES
COPD

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15
Q

What is prostatitis?

A

inflammation of the prostate gland

can be bacterial or nonbacterial
asymptomatic or symptomatic

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16
Q

How many categories of prostatitis are there and which is most common in the clinic?

A

4

category 3 - chronic pelvic pain syndrome

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17
Q

T/F: all four categories of prostatitis involve inflammation

A

false

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18
Q

Category 1 Prostatitis

A

acute bacterial prostatis

Bacterial infection of the prostate gland from GU infection (bacteria or virus) or sexually transmitted diseases

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19
Q

Symptoms of acute bacterial prostatitis (local and systemic)

A

pain or obstruction with voiding

pain in suprapubic, rectal, sacral, low back or perineum

fever, chills, nausea, emesis, arthralgia, myalgia, and malaise

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20
Q

Category II of prostatitis

A

chronic bacterial prostatitis

recurrent infection

21
Q

Symptoms of chronic bacterial prostatitis

A

low-grade symptoms as for category 1

flare-ups of pelvic pain

voiding problems

sexual dysfunction - ED, ejaculatory pain, decline in emotional wellbeing

22
Q

Category III Prostatitis

A

IIIA - chronic prostatitis (CP)
IIIB - Chronic Pelvic Pain (CPPS)

most common in clinic

23
Q

IIIA chronic prostatitis (CP) VS IIIB Chronic Pelvic Pain (CPPS)

A

IIIA (CP) - pain and urinary dysfunction WITH inflammation but WITHOUT infection

IIIB - Pain and urinary dysfunction WITHOUT inflammation or infection (AKA chronic nonbacterial prostatitis)

24
Q

Symptoms with CP or CPPS

A

GU, lower abdomen/pelvic, low

back pain, worse by sitting squatting or bending

irritative and obstructive voiding

sexual dysfunction

disturbed quality of life

25
Category IV of prostatitis
Asymptomatic Inflammatory Prostatitis
26
How is Asymptomatic Inflammatory Prostatitis diagnosed/found?
WBCs and inflammatory markers are found in semen or prostate tissue, usually when looking for infertility causes or testing for prostate cancer
27
What is Benign Prostatic Hyperplasia (BPH) and what is the criteria for it?
non-malignancy enlargement of the prostate gland prostate volume > 30 mL along with urinary tract symptoms and bladder outlet obstruction
28
___% of men over 50 experience symptoms of BPH
70%
29
BPH risk factors
age over 40 family history diabetes heart disease with beta blocker use obesity
30
Exercise ____ the risk pf BPH
decreases
31
How does BPH occur - what happens to cell growth ratio?
the ratio of new prostate cells to old prostate cells shifts in favor of lower cell death, causing increased growth (hyperplasia)
32
In BPH, the cell growth/hyperplasia grows in what direction? What does this cause?
grows inward in the peri-urethral region, compressing the urethra, obstructing urine flow, backing it up in the ureters and pooling in the kidney
33
Cancer of the prostate typically develops initially in the ____
periphery of the gland
34
Common symptoms of BPH
painful urination blood in urine unexplained low back pain or pelvis, hip, upper thigh pain sexual dysfunction
35
What are the ways to asses BPH (testing)?
digital rectal exam (DRE) prostate-specific antigen (PSA) blood test that is strongly related to prostate volume (normally < 4 ng/mL)
36
Mandatory assesment of BPH
history screening DRE Urinary analysis to rule out infection
37
"recommended" assessments for BPH
IPSS AUA-SI PSA
38
What is the most ocmmon cancer in american men?
prostate
39
what is the second most commmon cause of death of men behind lung cancer?
prostate cancer
40
1 in _ men will develop prostate cancer
6
41
_____carcinomas account for 98% of primary prostatic tumors
adenocarcinomas
42
Prostate cancer usually starts in the ____ portion of the prostate and works its way ____
outer inward
43
What causes prostate cancer?
the exact cause is unknown exercise may reduce risk
44
At what age is it a risk factor for prostate cancer
>50
45
Pathogenesis of prostate cancer
adenocarcinomas infiltrate the stroma of the prostate and invade adjacent structures, spreads to lymphatics (lymphatic metastasis)
46
Obstructive symptoms of prostate cancer are similar to BPH, what are they?
urinary urgency, frequency, hesitancy, dysuria, hematuria, difficulty initiating or continuing stream, decreased urine stream
47
Bony metastasis may occur in prostate cancer, where does this occur?
axial skeleton sacral and lumbar plexus
48
Dull aches from prostate cancer in the rectal, sacral or lumbar spine may result in
difficulty walking
49
Treatment of prostate cancer
radical prostatectomy - removal of whole prostate gland

Internal Med (26 decks)

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