structure and function of the lower urinary tract part 2 W2 Flashcards
features of normal bladder function?
bladder responsible for storage of urine
voiding initiated when bladder contains 300ml and it is socially convenient
normal pattern is 300-400ml, 4-5 per day (<7)
no urgency or incontinence
bladder diary?
collected by patient over 3 days
monitors input and output
most informative chart
storage LUTS (lower urinary tract symptoms)?
urgency
frequency
nocturia
UI (urinary incontinence)
voiding LUTS?
hesitancy
poor flow
intermittency
terminal dribbling
what can increased urinary production (polyuria) (type of storage LUTS) indicate?
DM/DI, excess fluid intake
what can decreased bladder capacity (type of storage LUTS) be due to?
reduced compliance
reduced functional capacity
neurogenic bladder
irritation
nocturia?
nocturnal frequency
normal nocturnal function?
<2x per night
what can nocturia be due to
ageing bladder
BOO (bladder outflow obstruction)
decreased compliance
dietary habits
effect of ageing on renal system?
renal concentrating ability decreases with age. increased renal blood flow at night (because less is being absorbed) leading to increased urine production
nocturnal polyuria?
production of more than 1/3 of 24-hour urine output between midnight and 0800
what are voiding symptoms due to
decreased force of micturition usually second to bladder outlet obstruction (BOO)
underactive/hypercontractile bladder
what is hesitancy
delay in start of micturition
what is intermittency? what can this be caused by?
involuntary start/stop
can be caused by prostatic enlargement
what is post void dribble? what is it caused by?
release of small amount of urine after micturition
caused by release of urine retained in bulbar/prostatic urethra
what is straining micturition?
use of abdominal muscles to void (Valsalva manoeuvre may be required at end of voiding)
when does straining occur?
in patients with underactive/hypercontractile bladder
what is urinary incontinence?
involuntary loss of urine that is a social or hygienic problem and is objectively demonstrable
types of incontinence
urge incontinence
stress incontinence
what is urge incontinence
involuntary loss of urine associated with a strong desire to void (detrusor contraction)
what is stress incontinence
involuntary loss of urine when intra-abdominal pressure rises without detrusor contraction (coughing, sneezing, laughing, straining, exerting)
how are LUTS assessed
take history (F/V chart or bladder diary)
examination (rectal in men to assess prostate)
urinalysis
special investigations
what are special investigations to assess LUTS?
IPSS (international prostate symptoms score)
flow rate and PVR (post void residual volume)
urodynamics
international prostate symptom score - 7 questions are related to which symptoms?
*frequency
*nocturia
*weak urinary system
*hesitancy
*intermittency
*incomplete bladder emptying
*urgency
IPSS scoring system?
7 questions = ?/35
0-7/35 = mild
8-19/35 = moderate
20-35/35 = severe
quality of life = ?/6
0 = delighted
1 = pleased
2 = mostly satisfied
3 = mixed
4 = mostly dissatisfied
5 = unhappy
6 = terrible
who fills out the IPSS
the patient
UroFlowMeter?
magic toilet
flow test and bladder scan on patient
assess voided volume
maximal urinary flow rate (Q max)
voiding time
subsequent bladder scan assesses residual volume
long voiding time with poor flow indicates?
bladder outflow obstruction (BOO)
Q max values indicate what?
<10ml/s = BOO
>15ml/s = normal
post voiding residual volume (PVR) values indicate what?
<100ml = insignificant
>200ml = significant
urodynamic assessment?
pressure transducers on bladder and rectum
pressure and rectum measured during filling and voiding
patient coughs periodically (checks transducers work)
subtracting rectal (abdominal) pressure from bladder = detrusor activity
which patients undergo urodynamic assessment?
those with complex voiding patterns
or suspected neurological underlying abnormalities
or young patients with severe symptoms
