Micturition Flashcards
Is the female or male bladder at higher pressure and why
Male - needs higher pressure to get urine out longer urethra
Is the male or female bladder larger
Female
What causes the bladder to reflexively squeeze
Sphincter opening
What innervation does the micturition centre sent out
Parasympathetic to detrusor
Somatic to sphincter
How are the pelvic nerves involved in the micturition reflex
Sensory feedback from bladder to micturition centre
Parasympathetic from micturition centre to detrusor muscle
What spinal routes are the pudendal nerve and pelvic nerves involved in the micturition reflex
S2 3 4
2 stages of the bladder cycle
Storage phase
Emptying phase
What stage of the bladder cycle is the bladder in the majority of the time
Storage phase
How much urine does the average adult pass in a day
1.5 litres
Why do emptying phase abnormalities in the bladder cycle not cause permanent damage to ureters and kidneys (except no function at all)
Phase is too short
How can chronic retention with overflow cause kidney failure
Urine transferred back up into ureters and kidney
What type of receptors are stimulated to contract the detrusor muscle
Muscarinic ACh receptors
Storage LUTS
Frequency
Nocturnal
Urgency
Urge incontinence
Voiding LUTS
Hesitancy
Straining
Poor flow
Intermittency
Incomplete emptying
General LUTS
Terminal dribbling
Dysuria
Haematuria
Overactive bladder
Urgency usually with frequency and nocturnal, sometimes with incontinence
How does an enlarged bladder sound on percussion
Dull
Why does the cardiovascular system affect the urinary system
Delivers fluid to urinary tract
What diagnostic tool is used to urinary tract problems
IPSS - international prostate symptom score
Input/output charts
What IPSS scores are mile, moderate, and severe
Mild - 0-7
Moderate - 8-19
Severe - 20+
Urinary tract investigations
Inspect urine sample
Urine dipstick
Urine culture and sensitivity
FBC
PSA
uroflowometry
Post voidable residual volume
Urodynamics
XR
Ultrasound
CT
Nuclear imaging
How does urinary flow rate change with age
Decrease
What causes end fill over activity
Bladder obstruction
3 types of micturition disorders
Anatomical
Functional
Medical
Causes of obstruction
Benign prostatic hypertrophy
Stones
Structures
Valves
Phimosis
Cancer
Causes of incontinence
Stress
Urge
Mixed urinary incontinence
Why does benign prostatic hyperplasia contract the urethra
Capsule around prostate gives prostate nowhere else to go
Lifestyle changes for LUTS
alter fluid type/amount
Bladder drills
Change foods
Stop smoking
Urethral milking
Pads and convenes
Why does caffeine increase bladder contraction
Releases calcium stored in Golgi apparatus of bladder walls
Why do some drinks such as coke and cranberry juice increase urination
Acidification irritates bladder
Drugs used for LUTS
alpha blockers
5 alpha reductase inhibitors
PDE5 inhibitors
Antimuscarinics
How do 5 alpha reductase inhibitors reduce constriction of urethra in men
Interfere with testosterone metabolism reducing prostatic hyperplasia
How do alpha blockers reduce urethra constriction in men
Prevent activation of alpha adrenergic receptors in urethra muscle preventing contraction and lumen narrowing
What is TURP
Electric loop carves out prostatic chips
What is HoLEP
Laser removal of prostatic tissue
What is UroLift
Mechanical technique to pull prostate tissue away from urethra
What is prostatic artery embolisation
Blocking arteries to prostate causing gland to shrink
What is rezum
Steam therapy
Types of urinary incontinence
Stress UI
Urge UI
mixed UI
How can urge incontinence be medically treated
Medication
How can stress incontinence be treated
Surgery
Urinary incontinence non-lifestyle treatments
Drugs
Posterior tibial nerve stimulation
Botox
Sacral nerve stimulation
Surgery
Drugs for urge incontinence
Anticholinergics
Beta3 andrenergics
Botulinum toxin A
How can beta3 adrenergics help urge incontinence
Beta3 adrenoreceptor upregulates in OAB
How can Botox help urge incontinence
Fuse synaptic vessels to motor end plate
How can anticholinergics help urge incontinence
Block ACh in parasympathetic nerves preventing bladder contraction
Why can anticholinergics cause dry mouth
Block ACh in salivary glands
Stress UI treatment
Pads
Fluid intake
Treat OAB
Kegal excercises
Vaginal cones
Mid urethral slings
Colposuspension
Lesions at what level of the micturition pathway are unsafe and can damage the bladder and kidneys
Between pontine micturition centre and T12
