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Urology NTN > Neuro-Urology > Flashcards

Neuro-Urology Flashcards

1
Q

Phases of bladder Function

A

Filling - Detrussor muscle stretches, Sphincter Contracts (constant low pressure)

Voiding Phase- Detrussor Contracts, Sphincter Relaxes

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2
Q

Innervation of LUT

A

Autonomic:
Pelvic Parasympathetic
Lumbar (Hypogastric) Sympathetic

Somatic:
Pudendal

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3
Q

Micturition Pathway

A

Afferent Sensory Information relayed to the Pontine Micturition Centre via spinothalamic tracts - known as the M Region then to the periaquaductal grey matter

Then relayed to frontal/pre-frontal/mid-brain for modulation before going back through PAG before **sacral efferent output **

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4
Q

Bladder Reflexes

A

There are a total of 4 lumbo-sacral reflexes modulated by the pontine micturition centre:

Pro-Continence:
Pelvo-hypogastric ( - Detrussor)
Pelvo-somatic, (- Detrussor , + Sphincter)
Somato-Pelvic (- Detrussor , + Sphincter)

Pro-Voiding:
Pelvo-Pelvic (+ Detrussor , - Sphincter)

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5
Q

Other than bladder reflexes - what supports continence

A

Volitional effort from sphincters + PF muscles

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6
Q

Which Muscarinic Receptor mediates Cholinergic Contractions

A

M3 (ACh -> Phospholipase C Hydrolydis -> Ca++ release -> SM contraction)

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7
Q

What do catecholomines do for continence

A

a-adrenoreceptor stimulation - BN + Urethral SM Contraction

Noradrenaline - B-Adrenorecptor mediated detrussor relaxation

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8
Q

Where can neurological conditions manifest in urological symptoms.

(4)

A

Brain
Suprasacral
Sacral
Peripheral

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9
Q

Pattern in suprascral injury

A

Detrussor Hyperreflexia
DSD
Reflex Bowel Emptying

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10
Q

Pattern in Sacral Injury

A

Areflexic Bladder -> Overflow incontinence
Adynamic anorectum

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11
Q

How can you test S2-S4

A

Bulbocavernosus Reflex

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12
Q

Baseline Investigations for Suspected Neurogenic DO/ DSD

A

Bloods, Urinalysis
USS
FR + PVR
Bladder Diary
QOL - Qualiveen

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13
Q

What is Qualiveen

A

A 30 item assessment instrument originally designed to assess QOL in patients with urological symptoms due to multiple sclerosis

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14
Q

NICE - who should get VUDS in context of neuro-urology

A

HIGH RISK of renal complications (Spina Bifida, SCI). Don’t routinely offer to patients with low risk of renal complications.

When consider surgical intervention

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15
Q

Non Invasive Treatment for Neurological Bladder

A

Behavioural Therapy
Bladder Rehabilitation
Drugs (storage + Voiding)

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16
Q

Drugs Available for :
Storage
Voiding

A

Storage:
Anti-muscarinics
B3 Agonist
Desmopressin

Voiding:
Alpha Antagonist
Muscarinic Agonist ( Bethanecol)

17
Q

Surgical Management
Stress UI due to Sphincter Inctoninence

A

AUS
Bladder Neck Sling
Sub Urethral Tape
Bulking Agent
Bladder Neck Closure

18
Q

Surgical Management
Incontinence 2o to Detrussor Underactivity / Sphincter Overactivity

A

Intraurethral Stent
Transurethral Incision of Sphincter
Botox to sphincter

19
Q

Surgical Management
DO
i) with DSD
ii) without DSD

A

i) Sacral Deafferentiation +/- CISC +/- Sacral Anterior Root Stimulation

ii) Bladder Botox / Enterocystoplasty/ Bladder autoaugmentation

20
Q

Which procedures decrease bladder contractility

A

Botox
Cystoplasty
Autoaugmentation

21
Q

What dose BOTOX do

A

Interacts with SNARE complex thus proventing neurotransmitter release and stopping SM contraction

22
Q

Which study for BOTOX in SCI + MS Patients

A

DIGNITY Study ->
i) Increased cytometric bladder capacity
ii) Decreases Voiding pressure
iii) Improved QOL
iv) higher incidence of UTI (50% vs 25%)/ Urinary Retention (6% vs 2.5%)

23
Q

Which procedures can enhance detrussor contractility

A

Sacral Anterior Root Stimulator
- Extradural/Intradural placement

24
Q

Procedures to decrease outlet resistance

A

External Sphincterotomy (TUI)
Urethral Stent
Botox to sphincter

25
Q

WHen to use prophylacitc antibiotics in patients with neuro-urological disorders

A

Symptomatic and once other causes for UTI have been treated ( Stones/ Stents etc.)

26
Q

Whati s Autonomic Dysreflexia

A

Massive Sympathetic Discharge 2o to stimulus ( usually bladder filling )
- Hypertension + bradycardia
- Empty bladder
- Nifedipine 10 mg

27
Q

Best choice of treatment for patient’s with Symtpoms 2o to poor bladder emptying

A

CISC

28
Q

What finding on VCMG indicats DSD

A

Blown Up Prostatic Fossa
Christmas Tree Bladder

Urology NTN (14 decks)

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