Renal 3

Question 1

what are the 3 parts of the urinary tract?

Answer 1

• urethra
• ureter
• -urinary bladder

Question 2

what is the micturition reflex?

Answer 2

Coordinates the process of urination

Question 3

how does the micturition reflex work?

Answer 3

1) Sensory fibers in the pelvic nerve ( stimulate ganglionic neurons ) sense stretch due to bladder filling
2) Parasympathetic fibers control muscle contraction
3) Interneurons communicate signals up to hypothalamus, with relays into the cortex
4) Voluntary relaxation of external sphincter results in urination

As the bladder fills with urine:
stretch receptors in urinary bladder (>500 ml):
stimulate pelvic nerve
stimulus travels from pelvic nerves:
stimulate ganglionic neurons in wall of bladder
postganglionic neuron in intramural ganglion:
stimulates detrusor muscle contraction
interneuron relays sensation to thalamus and deliver sensation to cerebral cortex
voluntary relaxation of external thus internal urethral sphincter

Question 4

what effects micturition reflex in infants

Answer 4

Lack voluntary control over urination

Corticospinal connections are not established

Question 5

what effects micturition reflex in elderly

Answer 5

Age related changes in urinary system
Decline in number of functional nephrons
Reduced sensitivity to ADH
Problems with micturition reflex

Question 6

Micturition reflex problems

Answer 6

1) Sphincter muscles lose tone: leading to incontinence

2) Control of micturition can be lost due to:
- a stroke
- Alzheimer’s disease
- CNS problems affecting cerebral cortex or hypothalamus

3) In males, urinary retention may develop if enlarged prostate gland compresses the urethra and restricts urine flow

Question 7

what is urinary incontinence?

Answer 7

Incontinence is defined as an involuntary loss of urine that is enough to cause a social or hygiene concern.

It is about four times more common in women than in men.
By the age of 75, at least 16% of women experience some incontinence, but younger women can also be affected.

Question 8

what are the three types of urinary incontinences in women?

Answer 8

• stress
• urge
• overflow

Question 9

what are the symptoms and causes for stress incontinence?

Answer 9

Stress incontinence:

Caused by coughing, sneezing, laughing or carrying heavy weights = normal control mechanism is weakened and urine is released

This can happen when the urethra moves out of the normal position (prolapses), after weakening of the pelvic floor muscles.

Stress incontinence is much more common in women than men and can be triggered by childbirth, hysterectomy and the menopause.

Question 10

what are the symptoms and causes of urge incontinence?

Answer 10

Strong urge to pass frequent, small amounts of urine.

Caused by the muscle of the bladder wall – known as the detrusor muscle - being overactive.

This means it contracts to squeeze out urine before the bladder is completely full.

Urge incontinence can also be caused by a bladder infection.

Diabetes can cause excessive production of urine and very frequent trips to the toilet (but large amounts of urine).

Mixed incontinence
Some women get both urge and stress incontinence. The two may or may not be linked.

Question 11

what is the symptoms and causes of overflow incontinence?

Answer 11

This happens when urine held by the bladder builds up to the point where the bladder can no longer expand.

It can be caused by an obstruction in the urinary tract or damage to the nerves that supply the bladder.

Bladder fills as normal but obstruction prevents it from emptying completely

Pressure from urine still in bladder builds up causing frequent leaks

Obstruction may be due to:
Stones
Constipation
Benign Prostatic Hypertrophy

Question 12

what can be other causes of urinary incontiences?

Answer 12

Other causes of incontinence:

Medication - The side-effects of some drugs:
angiotensin-converting enzyme (ACE) inhibitors
diuretics
some antidepressants
hormone replacement therapy (HRT)
sedatives

Problems with the urinary system such as fistulas (abnormal openings between the ureter, urethra or bladder into the uterus or vagina), and bladder stones.

Question 13

what are conservative (non-pharmacological) treatment for urinary incontience in women?

Answer 13

Pelvic floor muscle training (Kegel exercises)

Bladder training-
scheduled toileting (every 2-4h)
frequently empty the bladder and therefore keep the patient dry

Question 14

what are pharmacological) treatment for urinary incontience in women?
and their side effects

Answer 14

DULOXETINE moderate to severe stress urinary incontinence
SEROTONIN _ NOREPINEPHRINE REUPTAKE INHIBITOR
Can help increase the muscle tone of the urethra, which should help keep it closed
Also used for depression and neuropathic pain
Possible side effects of duloxetine can include:
- nausea
- dry mouth
- fatigue
- constipation

ANTIMUSCARINIC drugs reduce contractions of bladder and increase bladder activity- used for urge incontinence
Reduce symptoms of urgency and increase bladder capacity
Some also have direct relaxant effect on urinary smooth muscle
Examples:
Oxybutynin (Ditropan®),

Antimuscarinic side effects:
Dry mouth
Constipation
Blurred vision
Dry eyes
Fatigue
Drowsiness
Confusion (what about Alzheimer’s disease?)
Difficulty in micturition (less commonly urinary retention)
Angle closure glaucoma
Arrythmias and tachycardia

Tolterodine (Detrusitol®)
Solifenacin (Vesicare) cause relaxation of smooth muscle of bladder.

Question 15

what are surgical treatment for urinary incontience in women?
and their side effects

Answer 15

Surgical treatments
All forms of incontinence can be treated surgically.
Surgical correction should be considered only after all conservative options have been exhausted.
Long-term success rates are excellent with surgery, though complications do infrequently occur including
Infection
Bleeding
Continued incontinence
Inability to urinate.

Question 16

what is benign prostatic hyperplasia?

Answer 16

The prostate is a male reproductive gland.
Surrounds the urethra, the tube through which urine passes out of the body.
An enlarged prostate means the gland has grown bigger.
Prostate enlargement happens to almost all men as they get older. As the gland grows, it can press on the urethra and cause urination and bladder problems.
An enlarged prostate is often called benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy. It is not cancer, and it does not raise your risk for prostate cancer.

Question 17

what are the causes, incidence and risk factors of benign prostatic hyperplasia?

Answer 17

Causes, incidence, and risk factors

The likelihood of developing an enlarged prostate increases with age.
BPH is so common that it has been suggested that all men will have an enlarged prostate if they live long enough.
A small amount of prostate enlargement is present in many men over age 40 and more than 90% of men over age 80.
No risk factors have been identified other than having normally functioning testicles.

Question 18

what are the symptoms of benign prostatic hyperplasia?

Answer 18

Less than half of all men with BPH have symptoms of the disease, which include:
Dribbling at the end of urinating
Inability to urinate (urinary retention)
Incomplete emptying of your bladder
Incontinence
Needing to urinate two or more times per night
Pain with urination or bloody urine (these may indicate infection)
Slowed or delayed start of the urinary stream
Straining to urinate
Strong and sudden urge to urinate
Weak urine stream

Question 19

what are the tests which could be done for benin prostatic hyperplasia?

Answer 19

Digital rectal exam
Urine flow rate
Post-void residual urine test
Pressure flow studies to measure the pressure in the bladder as you urinate
Urinalysis to check for blood or infection
Urine culture to check for infection
Prostate-specific antigen (PSA) blood test to screen for prostate cancer
Cystoscopy (examination of the inside of the bladder)

Question 20

what are the medications which could be given for benign prostatic hyperplasia? and side effect

Answer 20

---Alpha 1-blockers are a class of medications also used to treat high blood pressure. 
Alfuzocin, Doxazocin, Indoramin, Prazocin, Tamsulosin, Terazocin

Relax the muscles of the bladder neck and prostate.
Allows easier urination. Most patients report symptom relief
Side effects- hypotension, syncope, dizziness, headache

— Finasteride and dutasteride lower levels of hormones produced by the prostate, reduce the size of the prostate gland, increase urine flow rate, and decrease symptoms of BPH.
It may take 3 to 6 months for improvement in symptoms.
Potential side effects related to the use of finasteride and dutasteride include decreased sex drive and impotence.

— Antibiotics (such as ciprofloxacin) may be prescribed to treat chronic prostatitis (inflammation of the prostate), which may accompany BPH.
Some men note relief of their BPH symptoms after a course of antibiotics.

– herbal
SAW PALMETTO

Question 21

when is surgery recommeneded for patients with benign prostatic hyperplasia?

Answer 21

Prostate surgery may be recommended if you have:

Incontinence 
Recurrent blood in the urine 
Inability to fully empty the bladder (urinary retention)
Recurrent urinary tract infections 
Kidney failure
Bladder stones

Other, less-invasive procedures are available. These use different forms of heat to destroy prostate tissue. None of these techniques have been proven to be better than surgery. Patients who receive these less-invasive procedures are more likely to need surgery again after 5 or 10 years.

Question 22

what are the complications with benign prostatic hyperplasia?

Answer 22

Men who have had long-standing BPH with a gradual increase in symptoms may develop:

Sudden inability to urinate 
Urinary tract infections 
Urinary stones 
Damage to the kidneys 
Blood in the urine
Even after surgical treatment, a recurrence of BPH may develop over time.