GU Flashcards
What anatomical structures make up the lower urinary tract?
Bladder -> bladder neck -> prostate gland -> urethra and urethral sphincter.
Involuntary control of the bladder and sphincter
Pelvic nerve: parasympathetic
S2,3,4
Hypogastric plexus: sympathetic
T11-L2
Pudendal nerve: somatic - Ach
S2,3,4 - controls sphincter
Afferent pelvic nerve
- sensory nerve
- signals from detrusor muscle
Voluntary neural control of the bladder and sphincter
Cortex: voluntary control
Pontine micturition centre/ PAG: coordination of voiding
Sacral micturition centre: micturition reflex
Onuf’s nucleus: Guarding reflex
Is the detrusor muscle relaxed or contracted during storage?
Relaxed.
Is the detrusor muscle relaxed or contracted during voiding?
Contracted.
Is the urethral sphincter relaxed or contracted during storage?
Contracted.
Is the urethral sphincter relaxed or contracted during voiding?
Relaxed.
What type of epithelium lines the bladder?
Urothelium (transitional epithelium) - pseudo-stratified.
Which part of the spinal cord is in charge of the guarding reflex?
Onuf’s Nucleus
What is the guarding reflex?
If voiding is inappropriate the guarding reflex occurs
Sympathetic (hypogastric) nerve stimulation results in detrusor relaxation
Pudendal nerve stimulation results in contraction of the external urethral sphincter
What is the micturition reflex?
Micturition reflex is an autonomic spinal reflex
Higher volumes stimulate the afferent pelvic nerve to send fast signals to the sacral micturition centre in the sacral spinal cord
Pelvic parasympathetic nerve is stimulated and the detrusor muscle contracts
Pudendal nerve is inhibited and the external sphincter relaxes
What are the 2 categories of erectile dysfunction?
- Organic e.g. vasculogenic, neurogenic, hormonal, anatomical.
- Psychogenic.
Give 3 characteristics of psychogenic erectile dysfunction.
Sudden.
Situational.
Younger males affected.
Give 4 risk factors for erectile dysfunction.
- Obesity.
- Lack of exercise.
- Smoking.
- Diabetes mellitus.
Investigations for erectile dysfunction?
- Blood pressure
- Essential bloods: fasting glucose & lipids, early morning testosterone
What is the first line pharmacological management of erectile dysfunction?
PDE5 inhibitors: Sildenafil (T1/2 4h), Tadalafil (T1/2 17.5h)
What is the second line pharmacological management of erectile dysfunction?
alprostadil
What is the third line pharmacological management of erectile dysfunction
Penile prosthesis implantation.
Premature Ejaculation POSSIBLE causes?
Anxiety
Early sexual experience
Reduced frequency of intercourse
Prostatitis: treatment can improve PE
Poor health & obesity
Association seen with Erectile Dysfunction
Management of premature ejaculation (list 4)
Behavioural & psychological:
1. counselling
2. stop/start manoeuvre
3. squeeze technique
Pharmacological:
1. Dapoxetine: short acting SSRI
2. Topical LA
3. PDE5 inhibitors if assoc ED
Normal function of the LUT
Convert a continuous process of excretion (urine production) to an intermittent process of elimination.
Store urine insensibly
Void urine when convenient
Neural control of the LUT
Parasympathetic (Cholinergic) S3-5
Drive detrusor contraction
Sympathetic (Noradrenergic) T10-L2
Sphincter/urethral contraction
Inhibits detrusor contraction
List 4 LUTS storage symptoms
- Frequency
- Nocturia
- Urgency
- Urgency Incontinence
List 4 LUTS voiding symptoms
Hesitancy
Straining
Poor/intermittent stream
Incomplete emptying
Post micturition dribbling
Haematuria
Dysuria
What are lower urinary tract symptoms (LUTS) in men > 50 likely to be due to?
Benign prostatic enlargement.
What is BPH?
Increase in epithelial and stromal cell numbers in the periurethral area of the prostate.
May be due to increase in cell number
Or due to decrease apoptosis
Or due to combination of the two
