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2A > GU > Flashcards

GU Flashcards

1
Q

What anatomical structures make up the lower urinary tract?

A

Bladder -> bladder neck -> prostate gland -> urethra and urethral sphincter.

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2
Q

Involuntary control of the bladder and sphincter

A

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

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3
Q

Voluntary neural control of the bladder and sphincter

A

Cortex: voluntary control

Pontine micturition centre/ PAG: coordination of voiding

Sacral micturition centre: micturition reflex

Onuf’s nucleus: Guarding reflex

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4
Q

Is the detrusor muscle relaxed or contracted during storage?

A

Relaxed.

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5
Q

Is the detrusor muscle relaxed or contracted during voiding?

A

Contracted.

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6
Q

Is the urethral sphincter relaxed or contracted during storage?

A

Contracted.

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7
Q

Is the urethral sphincter relaxed or contracted during voiding?

A

Relaxed.

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8
Q

What type of epithelium lines the bladder?

A

Urothelium (transitional epithelium) - pseudo-stratified.

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9
Q

Which part of the spinal cord is in charge of the guarding reflex?

A

Onuf’s Nucleus

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10
Q

What is the guarding reflex?

A

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

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11
Q

What is the micturition reflex?

A

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

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12
Q

What are the 2 categories of erectile dysfunction?

A
  1. Organic e.g. vasculogenic, neurogenic, hormonal, anatomical.
  2. Psychogenic.
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13
Q

Give 3 characteristics of psychogenic erectile dysfunction.

A

Sudden.
Situational.
Younger males affected.

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14
Q

Give 4 risk factors for erectile dysfunction.

A
  1. Obesity.
  2. Lack of exercise.
  3. Smoking.
  4. Diabetes mellitus.
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15
Q

Investigations for erectile dysfunction?

A
  1. Blood pressure
  2. Essential bloods: fasting glucose & lipids, early morning testosterone
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16
Q

What is the first line pharmacological management of erectile dysfunction?

A

PDE5 inhibitors: Sildenafil (T1/2 4h), Tadalafil (T1/2 17.5h)

17
Q

What is the second line pharmacological management of erectile dysfunction?

A

alprostadil

18
Q

What is the third line pharmacological management of erectile dysfunction

A

Penile prosthesis implantation.

19
Q

Premature Ejaculation POSSIBLE causes?

A

Anxiety
Early sexual experience
Reduced frequency of intercourse
Prostatitis: treatment can improve PE
Poor health & obesity
Association seen with Erectile Dysfunction

20
Q

Management of premature ejaculation (list 4)

A

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

21
Q

Normal function of the LUT

A

Convert a continuous process of excretion (urine production) to an intermittent process of elimination.
Store urine insensibly
Void urine when convenient

22
Q

Neural control of the LUT

A

Parasympathetic (Cholinergic) S3-5
Drive detrusor contraction

Sympathetic (Noradrenergic) T10-L2
Sphincter/urethral contraction
Inhibits detrusor contraction

23
Q

List 4 LUTS storage symptoms

A
  1. Frequency
  2. Nocturia
  3. Urgency
  4. Urgency Incontinence
24
Q

List 4 LUTS voiding symptoms

A

Hesitancy
Straining
Poor/intermittent stream
Incomplete emptying

Post micturition dribbling
Haematuria
Dysuria

25
Q

What are lower urinary tract symptoms (LUTS) in men > 50 likely to be due to?

A

Benign prostatic enlargement.

26
Q

What is BPH?

A

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

2A (7 decks)

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