Renal 3 Flashcards
what are the 3 parts of the urinary tract?
- urethra
- ureter
- -urinary bladder
what is the micturition reflex?
Coordinates the process of urination
how does the micturition reflex work?
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
what effects micturition reflex in infants
Lack voluntary control over urination
Corticospinal connections are not established
what effects micturition reflex in elderly
Age related changes in urinary system
Decline in number of functional nephrons
Reduced sensitivity to ADH
Problems with micturition reflex
Micturition reflex problems
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
what is urinary incontinence?
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.
what are the three types of urinary incontinences in women?
- stress
- urge
- overflow
what are the symptoms and causes for stress incontinence?
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.
what are the symptoms and causes of urge incontinence?
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.
what is the symptoms and causes of overflow incontinence?
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
what can be other causes of urinary incontiences?
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.
what are conservative (non-pharmacological) treatment for urinary incontience in women?
Pelvic floor muscle training (Kegel exercises)
Bladder training-
scheduled toileting (every 2-4h)
frequently empty the bladder and therefore keep the patient dry
what are pharmacological) treatment for urinary incontience in women?
and their side effects
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.
what are surgical treatment for urinary incontience in women?
and their side effects
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.
what is benign prostatic hyperplasia?
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.
what are the causes, incidence and risk factors of benign prostatic hyperplasia?
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.
what are the symptoms of benign prostatic hyperplasia?
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
what are the tests which could be done for benin prostatic hyperplasia?
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)
what are the medications which could be given for benign prostatic hyperplasia? and side effect
---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
when is surgery recommeneded for patients with benign prostatic hyperplasia?
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.
what are the complications with benign prostatic hyperplasia?
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.
