Lower urinary tract and UTIs Flashcards
What are the differences between the upeer and lower urinary tracts?
Lower= bladder and urethra
Upper= bilateral collecting systems and ureters
Why is there thicker bladder muscles in males?
The male bladder has a prostate gland below it- causes harder resistance for urine to pass through, so bladder muscles are thicker
What are the 3 layers of the bladder?
Urothelium- multilayered and has a barrier function
Lamina propria- functional centre, controls urothelium and detrusor muscles. Blood, vessels and nerve fibres are found here
Detrusor muscle- smooth and arranged in bundles.
What passively passes through the bladder/
It is not completely waterproof but it does resist water passage
There is passive passage of urea, Na+ and K+
How is voluntary voiding controls?
The spinobulbar reflex is modulated by the pontine micturition centre (PMC) in the pons.
Is known as Barrington’s nucleus
Also mediated by Onuf’s nucleus in the sacral area
What happens when voiding is initiated?
There is coordination of detrusor contraction and external urethral spihincter and urethral relaxation
What type of feedback loop is voiding controlled by?
Voiding is controlled by a positive feedback loop, as detrusor muscles contract, higher functions send efferent signals to increase detrusor contraction
What nerves are involved in volition?
Parasympathetic and pudendal
What is facilitation of voiding?
Early voiding e.g. in anxiety caused by higher centres
What are the excitory and inhibitory neurotransmitters involved in volition?
Excitory= ACh
Inhibitory= GABA and glycine
What can be used to check voiding patterns?
Can use frequency/volume chart which shows frequency, volumes passed and nocturia
Can also use a bladder diary that also shows input
What are lower urinary tract symptoms split into?
- STORAGE= urgency, frequency, nocturia and urinary incontinence
- VOIDING= hesitancy, poor flow, intermittency, terminal dribbling
What do storage symptoms reflect?
They reflect increased urinary production or decreased storage capacity
Could be excess fluid intake, MS, DM/DI
What is nocturia and what are the causes?
Nocturia- nocturnal frequency. Normal is < 2x a night. Caused by ageing bladder, bladder onstruction, dietary habits, decreased compliance
Renal concentrating ability decreases with age- less is absorbed so more urine produced
What are the voiding symptoms and what causes them?
Poor flow, hesitancy and dribble
Can be due to bladder outlet obstruction, urethral stricture (narrowing)
May also be due to an underactive/ hypocontractile bladder
What is incontience and what are the two types?
Defined as ‘involuntary loss of urine that is a social or hygienic problem and is objectively demonstrable
- Urge incontience= Involuntary loss of urine associated with strong desire to void (detrusor contraction)
- Stress incontience= –Involuntary loss of urine when intra-abdominal pressure rises without detrusor contraction eg with coughing, sneezing, laughing, straining, exerting
What is the international prostate symptom score?
Combines 7 questions and quality of life symptoms to get a score
What is a UroFlowMeter?
Uroflowmetry is a test that measures the volume of urine released from the body, the speed with which it is released, and how long the release takes.
What is Urodymanic assessment?
Pressure transducers placed to measure pressure in bladder and rectum. Subtracting rectal (abdominal) pressure from bladder = detrusor activity.
Helps find the cause
What does a normal urodynamic trace look like?
What does detrusor overactivity look like in a urodynamic trace?
What is the treatment for overactive detrusor activity?
Anti-muscarinic therapy or botox therapy
What does stress incontinence look like on a urodynamic trace?
What does high detrusor pressure associated with low urinary output volume indicate?
Bladder outflow obstruction
