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Renal and Urology > Structure and Function of Lower Urinary Tract > Flashcards

Structure and Function of Lower Urinary Tract Flashcards

1
Q

layers of bladder wall

A

transitional epithelium (aka urothelium)
lamina propria
submucosa
detrusor muscle
adventitia/serosa

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2
Q

do males or females have thicker detrusor muscles

A

males

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3
Q

how does the brain know the bladder is getting full

A

as the tight junctions between cells stretch signals are sent to the brain of the bladder filling
afferent neurons carry the signal to the dorsal horn of the sacral spinal cord

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4
Q

what system innervates the detrusor muscle

A

postganglionic parasympathetic system

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5
Q

what cells make up the urothelium

A

multilayered epithelium
apical/umbrella cells

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6
Q

what are the functions of the urothelium

A

forms a barrier
does afferent signalling - sends messages to CNS

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7
Q

which layer of the bladder are the blood vessels and nerves found

A

lamina propria

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8
Q

what is the function of the lamina propria

A

it coordinates the urothelium and the detrusor muscle

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9
Q

what type of cells are found in the lamina propria of the bladder

A

myofibroblasts

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10
Q

what is the detrusor muscle made from

A

smooth muscle arranged in bundles
it is a functional syncytium (fused cells with multiple nuclei)

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11
Q

what makes up the stroma of the bladder

A

collagen and elastin

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12
Q

what is the outer layer of the bladder

A

adventitia/serosa

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13
Q

what two things form the barrier function of the bladder

A

glycosamino glycans layer
tight junctions

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14
Q

what is and isn’t allowed to pass through the barrier layer of the bladder

A

urea, Na+ and K+ can pass passively
water passage is resisted but it is not completely waterproof

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15
Q

does bladder pressure increase when the urine increases in volume

A

no as the bladder is high compliant

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16
Q

what term describes the bladders ability to expand in response to urine without losing its tension

A

it is highly compliant

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17
Q

coordination of what two movements are required for volitional voiding

A

detrusor contraction
urethral relaxtion

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18
Q

what type of reflex comes under higher centre control in potty training

A

spino-bulbar reflex

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19
Q

at what volume of urine does the bladder begin to feel full

A

250ml

20
Q

at what volume of urine does the bladder begin to feel uncomfortabel

A

500ml

21
Q

which nerves control volitional voiding

A

S2, 3 and 4 (Onuf’s nucleus)

22
Q

where is volitional voiding modulated

A

pontine micturition centre

23
Q

what is facilitation

A

contraction of the detrusor and relaxation of sphincter when bladder less than full (e.g. in anxiety states)

24
Q

what is the likely result on voiding in a spinal cord injury

A

the CNS can no longer inhibit the reflex arc
so the bladder is left to empty under its reflex arc

25
Q

how much urine is normal to pass at one time and how many times a day

A

300-400ml
4-5 times per day

26
Q

what does a bladder diary measure

A

input and output
over three consequetive days
frequency
nocturia
hyperhydration
effects of caffiene
alcohol
binge drinking

27
Q

what are the storage lower urinary tract symptoms

A

urgency
frequency
nocturia
urinary incontinence

28
Q

what are the voiding lower urinary tract symptoms

A

hesitancy
poor flow
intermittency
terminal dribbling

29
Q

causes of decreased bladder capacity

A

reduced compliance
reduced functional capacity
neurogenic bladder (e.g. MS)
irritation (due to bladder stones or tumour)

30
Q

if someone wakes up to pee once every night do they have nocturia

A

no needs to be more than once

31
Q

why do those with peripheral oedema often have nocturia and what is the treatment

A

blood fluid can get to kidneys when lying down
given diuretic in afternoon to get rid of excess fluid before sleeping

32
Q

definition of nocturnal polyuria

A

production of more than one third of 24 hour urine output between midnight and 8am

33
Q

causes of poor flow, hesitancy, dribble

A

usually due to bladder outlet obstruction
or underactive or hypocontractile bladder (e.g. due to spinal cord injury)

34
Q

cause of intermittency

A

prostatic enlargement

35
Q

cause of post-void dribble

A

release of urine retained in bulbar/prostatic urethra

36
Q

what is straining

A

the use of abdominal muscles to void

37
Q

types of incontinence

A

urge - involuntary loss of urine associated with strong desire to void, involves detrusor contraction
stress - involuntary loss of urine when intra-abdominal pressure rises without detrusor contraction (e.g. coughing, sneezing, laughing, exerting)

38
Q

which type of incontinence involves detrusor muscle contraction

A

urge incontinence

39
Q

what is IPSS

A

internal prostate symptom score

40
Q

what 8 questions are included in the IPSS

A

frequency
nocturia
weak urinary stream
hesitancy
intermittency
incomplete bladder emptying
urgency
quality of life

41
Q

what is involved in the urodynamic assessment

A

pressure transducers are placed on the bladder and rectum which measures the pressure here in filling and voiding
patient is asked to cough periodically

42
Q

how is detrusor activity calculated in a urodynamic assessment

A

pressure from bladder - pressure from rectum

rectum pressure = abdominal pressure

43
Q

results of a urodynamic assessment for someone with bladder outlet obstruction

A

no unstable contractions during filling
no leak whilst coughing during filling
very high pressure and low flow during voiding

44
Q

what order are symptoms of outflow obstruction likely to arise in

A
  1. storage symptoms
  2. voiding symptoms
  3. decompensation of detrusor (chronic retention, bladder failure and renal failure)
45
Q

management of over active bladdr

A

lifestyle (e.g. cutting back on caffeine)
medication (e.g. anti-muscarinics, selective B3 adrenoreceptor agonist, intradetrusor botox)

46
Q

management of stress incontinence

A

pelvic floor exercises
weight loss
surgery

47
Q

management of bladder outlet obstruction

A

alpha blockers
5ARI
surgery

Renal and Urology (16 decks)

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