Jan16 M2-LUTS

Question 1

what type of cells in the pelvis

Answer 1

transitional

Question 2

two ways to control continence and how controlled

Answer 2

bladder neck (internal sphincter): by ANS
external sphincter, skeletal muscle

Question 3

normal things bladder should do to store urine (2) (when don’t want to pee)

Answer 3

low detrusor pressure (SS activity to relax the SM) + PSS inhibition

Question 4

what affects bladder compliance (common ones)

Answer 4

neurological problem, diabetes (neuropathy), fibrosis , prolonged obstruction

Question 5

what can cause obstruction

Answer 5

enlarged prostate for a long time (high R downstream)

Question 6

external sphincter what type of control and what nerve

Answer 6

somatic. pudendal nerve

Question 7

2 types of fibers in the external sphincter (or distal or rhabdo sphincter) + fct

Answer 7

slow-twitch: (type I) maintain skm resting tone

fast-twitch: (type IIa) rapid response to sudden rises in intra-abd coughing

Question 8

why females more prone to incontinence (3)

Answer 8

• post menopause atrophy in submucosa (harder to fight P)
• shorter urethra (less downstream P)
• misalignement from anatomical changes (bladder prolapse, cystocele)

Question 9

CNS actions when you want to pee (what part of the brain starts it all and what it acts on)

Answer 9

• pontine micturition center. inhibits guarding relaxation

- sacral micturition center (S2 to S4)

Question 10

2 brain centers for micturition: 3 things they do

Answer 10

• relax skm of external sphincter
• rise in detrusor P
• open bladder neck (ANS)

Question 11

two types of LUTS

Answer 11

irritative and obstructive

Question 12

irritative LUTS

Answer 12

dysuria
incontinence
urgency
frequency
hematuria
nocturia

Question 13

obstructive LUTS

Answer 13

frequency
hesitancy
intermittency
incomplete emptying
weak stream
retention
straining
terminal dribbling

Question 14

intermittency def

Answer 14

must force abd muscles but intermittently bc get tired

Question 15

straining def

Answer 15

have to force

Question 16

terminal dribbling def

Answer 16

urine falls slowly in drops of a thin stream

Question 17

main reason for obstruction

Answer 17

prostate enlargement

Question 18

main risk factors for LUTS

Answer 18

age, obesity, diabetes, ETOH intake, phys activity

Question 19

main meds that affect voiding

Answer 19

anticholinergics: relax bladder SM
CCB: relax bladder SM
alpha blockers: decrease outlet resistance
alpha agonist: increase outlet R

Question 20

3 other meds that relax the bladder and increase outlet resistance

Answer 20

• narcotis
• antipsychotics
• antihistamines

Question 21

overactive bladder def and caues

Answer 21

SS too weak. fail to act as a low P storage

causes: neurogenic or myopathic

Question 22

LUTS in overactive bladder

Answer 22

urgency, frequency, incontinence maybe

Question 23

management of overactive bladder

Answer 23

• anticholinergic
• catheterization
• cystostomy, surgical bladder augmentation

Question 24

4 voiding dysfunctions ex

Answer 24

• overactive bladder
• obstruction (BPH)
• urinary incontinence
• urinary retention

Question 25

retention causes

Answer 25

- bladder prob (neuro, pharmaco, myopathic) | - outlet prob (prostate obstruction, stricture, neck contracture, neuro (sphincter))

Question 26

incontinence causes

Answer 26

- bladder prob (neuro, myopathic, retention with overflow incontinence) - outlet prob (sphincter prob, stress incontinence = anato)

Question 27

BPH def

Answer 27

benign prostatic hyperplasia

Question 28

hyperplasia of what cells in BPH

Answer 28

``` glandular tissue (epithelial cells) prostate stroma (SM) ```

Question 29

how prostate develops

Answer 29

testosterone (T) converted to dihydrotestosterone (DHT) by 5-alpha reductase. DHT is a more potent androgen, acts for prostate dev

Question 30

how BPH leads to LUTS (2)

Answer 30

- pressure on urethra from prostate bulk | - higher SM tone in prostate and urethra

Question 31

how detrusor reacts to BPH over time

Answer 31

becomes hypertrophic

Question 32

4 prostate zones

Answer 32

transitional, central, peripheral, fibromuscular stroma

Question 33

prostate zones with BPH and with cancer

Answer 33

BPH in transitional | peripheral: cancer

Question 34

rectal exam to check what and why

Answer 34

for prostate CANCER (peripheral zone in front of the rectum)

Question 35

2 scores to evaluate for LUTS

Answer 35

``` IPSS score (international prostate symptom score) AUA (Am Urol ASsoc Symptom score) ```

Question 36

most common cause of LUTS

Answer 36

UTI

Question 37

ddx for LUTS and how to differentiate

Answer 37

UTI, neuro, BPH, cancer, stricture, diabetic neuropathy, etc. LAB TESTS + history

Question 38

PSA meaning and shows what (test)

Answer 38

blood prostate specific antigen. shows prostate enlargement or cancer or infection

Question 39

high sensitivity testing for prostate cancer

Answer 39

DRE AND PSA

Question 40

complications of BPH

Answer 40

UTI, overflow incontinence, urinary retention, renal fialure

Question 41

hematuria workup and how to check for the cause

Answer 41

- imaging of upper urinary tract | - cystoscopy for lower urinary tract

Question 42

BPH and PSA

Answer 42

PSA high

Question 43

principle in diagnosing BPH and how to do it

Answer 43

by elimination. rule out renal failure by physical exam. DRE to rule out cancer. (stones, other cancer)

Question 44

labs to do in LUTS

Answer 44

UA, urine culture, PSA, uroflow scan

Question 45

BPH = dx by exclusion. what to rule out b4 BPH

Answer 45

UTI, prostate infection, cancer, prostate cancer, neuro voiding problem

Question 46

non-pharma vs pharma options in BPH

Answer 46

non-pharma: timed voiding, double voiding | pharma: alpha blockers, 5 alpha reductase inhibitors, anticholinergics

Question 47

alpha blockers act on what

Answer 47

alpha-1 adrenergic receptors in prostatic SM and in the bladder neck

Question 48

alpha receptors type in the prostate, bladder, vasculature and CNS

Answer 48

prostate: alpha 1a bladder: alpha 1d vasculature: alpha 1a and alpha 1b CNS: alpha 1b

Question 49

2 drugs (alpha 1 a blockers)

Answer 49

tamsulosin | silodosin

Question 50

2 5-alpha-reductase inhibitors and what type

Answer 50

finasteride (type2) | dutasteride (type 1 and 2 inhibitor)

Question 51

surgeries in BPH + most common

Answer 51

TURP (most common), TUIP (incision rather than resection)

Question 52

criteria for referring LUTS to a urologist

Answer 52

- intense symptoms - young patients - meds side effects too bad - BPH complications - complex presentation