Micturition Flashcards
Why do men’s bladders work at a higher pressure than womens? [1]
Male urethra is longer - requires greater pressure to push further
Explain how the micturition reflex works
Full bladder: sensory feedback from S2-4) to micturition centre
micturition centre sends signal to brain to ask if socailly acceptable to urinate or not
if yes: able to control sphincter via somatic nature of pudendal nerve AND parasympathetic action of detrusor muscle, contracting the bladder
FYI
The bladder spends most of time in [] mode
storage mode - only contracts 0.3% of life !
Normal bladder contraction is caused by the release of []
The release of [] causes the stimulation of [] receptors on the [] smooth muscle
Normal bladder contraction is caused by the release of Ach
The release of Ach causes the stimulation of muscarininc receptors on the detrusor smooth muscle
What are lower urinary tract symptoms?
- storage symptoms? [4]
- voiding symptoms? [5]
- post-micturition [2]
What is important to recogonise with them?
Storage symptoms:
- frequency
- nocturia
- urgency
- urge inconteninence
Voiding symptoms:
* Hesitancy
* Straining
* Poor flow
* Intermittency
* Incomplete emptying
post-micturition:
* dribbling
Most of the time the symptoms present together / not individually to voiding symptoms
What is an overactive bladder? [1]
What do ptx normally present with? [2]
inability to postpone voiding - need to urinate
usually present wtih nocturia
may present with incontinence
FYI Diagnosis
Most important question to ask with a patient is what? [1]
How bad is it? (can they live with symptoms)
Which diagnostic score would use to assess micruition? [2]
What would scores be for mild, moderate and severe? [3]
Internation Prostate Symptom Score (IPSS)
Mild: 0-7
Moderate: 8-19
Severe: 20-35
AND
Input / Output Chart = voiding diary to create a frequency / volume chart
How would you investigate micturition problems? [6]
- inspect fresh urine sample
- urine dipstick
- FBC, PSA (prostatic specific antigen)
- Uroflowmetry
- Ultrasound and CT scans
- Nuclear imaging (for kidney obstruction)
What does a normal flow-rate recording look like?
Fast and short
20 ml/s = unobstructed
How does urinary flow rate change with age? [1]
Decreases with age
Most common is to have:
voiding symptoms only
storage symptoms only
post-micturition symptoms only
storage & voiding symptoms
storage & voiding & post-mic symptoms
Most common is to have:
voiding symptoms only
storage symptoms only
post-micturition symptoms only
storage & voiding symptoms
storage & voiding & post-mic symptoms
What is an important consideration with regards to treating bladders?
When a bladder is obstructed, starts to contract a bit randomly: causes changes in pressure (and symptoms)
Bladder isnt overactive - is just blocked.
If treat overactivity then might not do anything - so need to treat blockages
What are 3 classifications for micturition disorders? [3]
anatomical disorders
* obstruction
* incontinence
functional disorders
* stroke / spinal cord injury / neurological disease
Medical disorders
* Cardiac, hepatic and renal failure
OR can think of classifications of mic. disorders in which way? [4]
Describe pathophysiology of benign prostate hyperplasia
Prostate undergoes hyperplasia - obstructs urethra
Causes detrusor hyperplasia
Name some Conservative management for lifestyle advise? [6]
Fluid
Type
Amount
Bladder Drill
Food
Smoking
Urethral Milking
Pads & Convenes
NOT CATHETERS! – last resort, and CISC best type
How can you adapt fluid management for patients?
What is aim for ml of urine per day?
How can you measure how much urine making each day?
Wee more / less depending on fluid intake
Dehydrated urine causes bladder iritation
Aim for 1500ml - 2000ml urine
Measure using voding diary
Effect of caffeine on bladder? [1]
Causes release of calcium stores from GA in the bladder wall
Causes contraction more likely
What is a big risk factor for bladder cancer? [1]
What foods are risks for bladder irritation? [3]
smoking
onions, chilli and spicy food
What is urethral milking?
Put hands behind testicles and bring forward after urinating to ensure all urine is expelled from U bend in urethra (stops dribbling)
Explain drugs used to treat bladder problems [4]
alpha blockers(‘stretchers’): stretch prostates open
5-alpha reductase Inhibitors: (‘shrinkers’) shrink prostates
PDE5 inhibitors
Antimuscarinics (for OAB)
Combination
FYI
Also get surgery for LUTS
What is difference between stress and urge urinary incontinence? [2]
Stress UI: Leakage on effort or exertion (increased abdominal pressure)
Urge UI: Leakage accompanied by urgency
What is difference between stress and urge urinary incontinence? [2]
Stress UI: Leakage on effort or exertion (increased abdominal pressure)
Urge UI: Leakage accompanied by urgency
Explain how stress incontinence occurs
weaking of pelvic floor or urethral sphincter
support is diminished, this causes intra-abdominal pressure to push more urine into urethra
Explain how urge incontinence occurs
Larger squeezes on bladder muscle occur
overcomes sphincter and urine comes out urethra
How do you prioritise treatment options for urge incontinence / overactive bladder? [7]
- Always treat overactive component first
- Next approach conservative measures (fluid intake / caffiene / pads)
- Next pelvic floor exercises
- Tablets
- Botox
- Posterior and / or sacral nerve stimulation
- surgery
Explain 3 drugs used for urge incontinence / OAB [3]
Where in the body are regions safe if neurogenic damage occurs? [2]
Where is not safe? [1]
Safe:
- Lesions above pontine micturition centre
- Lesions below T12
Unsafe:
- Between mic. centre and T12: causes loss of coordination and raises bladder pressure
