structure and function of the lower urinary tract part 2 W2

Question 1

features of normal bladder function?

Answer 1

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

Question 2

bladder diary?

Answer 2

collected by patient over 3 days
monitors input and output
most informative chart

Question 3

storage LUTS (lower urinary tract symptoms)?

Answer 3

urgency
frequency
nocturia
UI (urinary incontinence)

Question 4

voiding LUTS?

Answer 4

hesitancy
poor flow
intermittency
terminal dribbling

Question 5

what can increased urinary production (polyuria) (type of storage LUTS) indicate?

Answer 5

DM/DI, excess fluid intake

Question 6

what can decreased bladder capacity (type of storage LUTS) be due to?

Answer 6

reduced compliance
reduced functional capacity
neurogenic bladder
irritation

Question 7

nocturia?

Answer 7

nocturnal frequency

Question 8

normal nocturnal function?

Answer 8

<2x per night

Question 9

what can nocturia be due to

Answer 9

ageing bladder
BOO (bladder outflow obstruction)
decreased compliance
dietary habits

Question 10

effect of ageing on renal system?

Answer 10

renal concentrating ability decreases with age. increased renal blood flow at night (because less is being absorbed) leading to increased urine production

Question 11

nocturnal polyuria?

Answer 11

production of more than 1/3 of 24-hour urine output between midnight and 0800

Question 12

what are voiding symptoms due to

Answer 12

decreased force of micturition usually second to bladder outlet obstruction (BOO)

underactive/hypercontractile bladder

Question 13

what is hesitancy

Answer 13

delay in start of micturition

Question 14

what is intermittency? what can this be caused by?

Answer 14

involuntary start/stop
can be caused by prostatic enlargement

Question 15

what is post void dribble? what is it caused by?

Answer 15

release of small amount of urine after micturition
caused by release of urine retained in bulbar/prostatic urethra

Question 16

what is straining micturition?

Answer 16

use of abdominal muscles to void (Valsalva manoeuvre may be required at end of voiding)

Question 17

when does straining occur?

Answer 17

in patients with underactive/hypercontractile bladder

Question 18

what is urinary incontinence?

Answer 18

involuntary loss of urine that is a social or hygienic problem and is objectively demonstrable

Question 19

types of incontinence

Answer 19

urge incontinence
stress incontinence

Question 20

what is urge incontinence

Answer 20

involuntary loss of urine associated with a strong desire to void (detrusor contraction)

Question 21

what is stress incontinence

Answer 21

involuntary loss of urine when intra-abdominal pressure rises without detrusor contraction (coughing, sneezing, laughing, straining, exerting)

Question 22

how are LUTS assessed

Answer 22

take history (F/V chart or bladder diary)
examination (rectal in men to assess prostate)
urinalysis
special investigations

Question 23

what are special investigations to assess LUTS?

Answer 23

IPSS (international prostate symptoms score)
flow rate and PVR (post void residual volume)
urodynamics

Question 24

international prostate symptom score - 7 questions are related to which symptoms?

Answer 24

*frequency
*nocturia
*weak urinary system
*hesitancy
*intermittency
*incomplete bladder emptying
*urgency

Question 25

IPSS scoring system?

Answer 25

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

Question 26

who fills out the IPSS

Answer 26

the patient

Question 27

UroFlowMeter?

Answer 27

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

Question 28

long voiding time with poor flow indicates?

Answer 28

bladder outflow obstruction (BOO)

Question 29

Q max values indicate what?

Answer 29

<10ml/s = BOO
>15ml/s = normal

Question 30

post voiding residual volume (PVR) values indicate what?

Answer 30

<100ml = insignificant
>200ml = significant

Question 31

urodynamic assessment?

Answer 31

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

Question 32

which patients undergo urodynamic assessment?

Answer 32

those with complex voiding patterns
or suspected neurological underlying abnormalities
or young patients with severe symptoms