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Urinary System > Incontinence And Malignancy > Flashcards

Incontinence And Malignancy Flashcards

1
Q

Which nerve controls the detrusor muscle?

A

PNS pelvic nerves
S2-4
Involuntary

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2
Q

Which nerve controls the external urethral sphincter?

A

Somatic pudendal nerve

S2-4

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3
Q

Describe the positions of the external sphincter

A

Usually contracted

Relaxes when voiding

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4
Q

How does a lower motor neurone lesion affect the bladder and anus?

A 
Low detrusor pressure
No action 
Large volume of residual urine -> overflow incontinence 
Can't feel the bladder filling
Reduced perianal sensation 
Lax anal tone
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5
Q

How does an upper motor lesion affect the bladder?

A

Constantly contracting the detrusor muscle
Poor coordination with sphincters
(Detrusor-sphincter dyssynergia)
Urine can go up, dilate the ureters and cause damage to the kidneys

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6
Q

How do we classify lower urinary tract symptoms?

A

By phase:
Storage
Voiding
Post-micturition

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7
Q

Describe some LUT symptoms of the storage phase

A

Frequency
Urgency
Nocturia
Incontinence

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8
Q

Describe some LUT symptoms of the voiding phase

A 
Slow stream 
Spitting/spraying
Intermittency 
Hesitancy 
Straining 
Terminal dribble
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9
Q

Describe some LUT symptoms of post-micturition

A

Dribble

Feeling of incomplete emptying

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10
Q

Define urinary incontinence

A

The complaint of any involuntary leakage of urine

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11
Q

How does incontinence affect quality of life?

A

Depression
Social exclusion - don’t want to go out
Sense of shame

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12
Q

What are the different types of incontinence?

A

Stress
Urge
Mixed
Overflow

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13
Q

Describe stress urinary incontinence

A

Involuntary leakage on effort/exertion or on sneezing/coughing

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14
Q

Describe urge incontinence

A

Involuntary leakage accompanied by or immediately proceeded by urgency

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15
Q

Describe mixed urinary incontinence

A

Associated with urgency and also afford/exertion/coughing/sneezing

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16
Q

Describe overflow incontinence

A

Bladder accepts more and more urine without any action

Eventually it dribbles out due to the large volume

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17
Q

Describe the symptoms associated with overactive bladder syndrome

A

Urgency
Frequency
Nocturia

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18
Q

What is more common, overactive bladder or urge incontinence?

A

Overactive bladder syndrome

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19
Q

Why does the prevalence of urinary incontinence increase with age?

A

Bladder more sensitive
Smaller
Less able to hold urine

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20
Q

Describe how BPH affects urinary incontinence

A

Enlarged prostate blocks urine flow
Bladder gets larger and larger until cannot distend anymore
Starts to leak
Overflow incontinence

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21
Q

What is the most common type of urinary incontinence?

A

Stress

Due to weak pelvic floor muscles

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22
Q

Give some risk factors for urinary incontinence

A 
Family predisposition 
Anatomical abnormalities 
Neurological abnormalities 
Co-morbidities
Increased intraabdominal pressure
UTI 
Menopause
Pregnancy/childbirth 
Pelvic surgery 
Pelvic prolapse
Obesity 
Age 
Cognitive impairment 
Drugs 
Race
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23
Q

What examinations would you do for someone with incontinence?

A

BMI
Abdominal exam (palpable bladder?)
DRE - check prostate
Females - external genitalia and vaginal exam

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24
Q

What is the mandatory investigation for urinary incontinence?

A

Urine dipstick

Check for UTI, haematuria, proteinuria, glycosuria etc

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25
Q

After a urine dipstick, what other investigations could you do for incontinence?

A

Urodynamics: frequency-volume chart, bladder diary, post-micturition residual volume (USS)
Pressure flow studies
Pad tests
Cystoscopy

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26
Q

What different factors does the management of incontinence depend on?

A

Symptoms
Degree of nuisance
Effects of treatment
Previous/current treatments

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27
Q

What is the general advice for someone experiencing urinary incontinence?

A

Lose weight
Decreased caffeine intake
Stop smoking
Try to regulate bowel movements

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28
Q

What is contained incontinence?

A

For patients unsuitable for surgery who have failed conservative/medical management
Condom catheters
Urethral/suprapubic catheter
Incontinence pads

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29
Q

Describe pelvic floor muscle training

A

8 contractions
3 times a day
For at least 3 months
Patients are not usually very compliant with this

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30
Q

Describe how duloxetine works to treat stress incontinence

A

Combined adrenaline and serotonin uptake inhibitor
Increased activity in external sphincter during filling so more likely to remain closed
Has many side effects

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31
Q

Describe the surgical options for women with incontinence

A

Low tension vaginal tapes
Suspension procedures
Classical sling procedure

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32
Q

What are the surgical options for men with incontinence?

A

Artificial (hydraulic) urinary sphincter

Male sling

33
Q

How does an intramural bulking agent work for incontinence?

A

Decrease the lumen of the urethra to help retain urine

Eg. Collage/silicone

34
Q

What is the short hand for prostate cancer?

A

CaP

35
Q

What is the commonest cancer of men in the UK?

A

Prostate

36
Q

What is the usual presentation of prostate cancer?

A 
Asymptomatic 
Have localised disease 
Unlikely to die of it 
Urinary symptoms of BPH, bladder overactivity 
Bone pain 
Unusual to have haematuria
37
Q

Give some CaP risk factors

A

Increasing age
Family Hx
BRCA2 gene mutation
Ethnicity (black>white>asian)

38
Q

What are the issues with PSA screening?

A 
Overdiagnosis 
Overtreatment
Quality of life 
Cost effectiveness 
There are other causes of increased PSA
39
Q

Other than cancer, what causes a raised PSA?

A

Infection
Inflammation
Large prostate

40
Q

How do we make a diagnosis of CaP?

A

Digital rectal examination
And
Serum PSA

41
Q

What investigations do we do for CaP?

A

Serum PSA
Transrectal ultrasound-guided biopsy of prostate for histology
MRI/bone scan to look for mets

42
Q

If the PSA is greater than which number do we rarely consider removal?

A

> 20

43
Q

What do we assess looking for cancer with a biopsy of the prostate?

A 
Gleason grade (low magnification)
Extent (how involved the core is)
44
Q

What are the established treatments for localised CaP?

A

Surveillance (PSA)
Radical prostatectomy
Radiotherapy

45
Q

Name some developmental treatments for localised CaP treatment

A

HIFU
Primary cryotherapy
High dose rate brachytherapy

46
Q

Give some treatments for metastatic prostate cancer treatment

A

Surgical castration
Medical castration - given LHRH agonists
(LH and testosterone start to decrease)

47
Q

Give some treatments that can help with palliative care of CaP

A

Single dose radiotherapy
Bisphosphonates
Chemotherapy

48
Q

What type of bone metastases does CaP make?

A

Sclerotic

‘Hot spots’ on bone scans

49
Q

Under which PSA are bone mets unlikely?

A

< 10

50
Q

What are the treatments for locally advanced CaP?

A

Surveillance
Hormones
Hormones and radiotherapy

51
Q

Give a differential diagnosis for haematuria

A 
Renal cell carcinoma
Upper tract transitional cell carcinoma
Bladder cancer
Advanced prostate carcinoma
Stones
Infection 
Inflammation 
BPH 
Nephrological (glomerular)
52
Q

What do we need to ask about in a Hx with haematuria?

A 
Smoking
Occupation 
Pain 
Other lower urinary tract symptoms 
Family Hx
53
Q

What do we examine if someone presents with haematuria?

A 
BP 
Abdominal masses 
Varicocele 
Leg swelling (lymphoedema) 
DRE
54
Q

What investigations would we carry out for someone with haematuria?

A

Blood - FBC, U+E
Ultrasound - any tumours or stretching
Flexible cystoscopy
Urine - culture and cytology

55
Q

Is bladder cancer commoner in males or females?

A

Males

56
Q

Is the incidence of bladder cancer increasing or decreasing?

A

Decreasing

57
Q

What is the commonest type of bladder cancer?

A

Transitional cell carcinoma

58
Q

Give some risk factors for bladder cancer

A

Smoking
Occupational exposure - rubber, plastics, carbon, paint, dyes
Schistosomiasis

59
Q

Which type of bladder cancer is schistosomiasis linked to?

A

Squamous cell carcinoma

60
Q

What is the treatment for bladder cancer?

A

Resect the tumour

Chemotherapy into the bladder

61
Q

What percentage of bladder cancers are superficial on diagnosis?

A

75%

62
Q

How do we grade bladder cancer?

A

Traditional high magnification grading system

Mitotic bodies, nuclei size and ratio etc

63
Q

What is the potentially curative treatment for muscle-invasive bladder cancer?

A

Radical cystectomy or radiotherapy

+/- chemotherapy

64
Q

What is a radical cystectomy?

A

Removal of the bladder
(In women also remove the womb and ovaries)
Redirect urine to come out of the abdominal wall

65
Q

95% of all upper urinary tract tumours are which type?

A

Renal cell carcinoma

66
Q

Is the incidence of renal cell carcinoma increasing or decreasing?

A

Increasing

67
Q

Is renal cell carcinoma more common in males or females?

A

Males

68
Q

What percentage of renal cell carcinomas have mets on presentation?

A

30%

69
Q

What are the risk factors for renal cell carcinoma?

A

Smoking
Obesity
Dialysis

70
Q

Describe the different ways renal cell carcinomas can spread

A

Perinephric
Lymph nodes
IVC spread to right atrium - forms a thrombus

71
Q

What imaging can we use to diagnose renal cell carcinoma?

A

Ultrasound

CT

72
Q

What are the treatments for RCC?

A

Surveillance
Radical nephrectomy
Partial nephrectomy
Ablation (developmental)

73
Q

Describe the treatment for metastatic RCC

A

Palliative

Molecular therapies

74
Q

What are the causes of upper tract transitional cell carcinoma?

A

Smoking
Phenacetin abuse
Balkan’s nephropathy

75
Q

What percentage of upper urinary tract tumours are transitional cell carcinomas?

A

5%

76
Q

What percentage of people who develop upper urinary tract cancer develop bladder cancer?

A

40%

77
Q

What investigations would we do for upper tract transitional cell carcinoma?

A

Ultrasound for hydronephrosis
CT urogram
Retrograde pyelogram
Ureteroscopy - biopsy

78
Q

What is the standard treatment for upper tract transitional cell carcinoma?

A

Nephro-ureterectomy

Urinary System (14 decks)

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