structure and function of the lower urinary tract part 2 W2 Flashcards

1
Q

features of normal bladder function?

A

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

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2
Q

bladder diary?

A

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

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3
Q

storage LUTS (lower urinary tract symptoms)?

A

urgency
frequency
nocturia
UI (urinary incontinence)

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4
Q

voiding LUTS?

A

hesitancy
poor flow
intermittency
terminal dribbling

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5
Q

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

A

DM/DI, excess fluid intake

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6
Q

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

A

reduced compliance
reduced functional capacity
neurogenic bladder
irritation

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7
Q

nocturia?

A

nocturnal frequency

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8
Q

normal nocturnal function?

A

<2x per night

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9
Q

what can nocturia be due to

A

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

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10
Q

effect of ageing on renal system?

A

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

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11
Q

nocturnal polyuria?

A

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

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12
Q

what are voiding symptoms due to

A

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

underactive/hypercontractile bladder

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13
Q

what is hesitancy

A

delay in start of micturition

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14
Q

what is intermittency? what can this be caused by?

A

involuntary start/stop
can be caused by prostatic enlargement

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15
Q

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

A

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

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16
Q

what is straining micturition?

A

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

17
Q

when does straining occur?

A

in patients with underactive/hypercontractile bladder

18
Q

what is urinary incontinence?

A

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

19
Q

types of incontinence

A

urge incontinence
stress incontinence

20
Q

what is urge incontinence

A

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

21
Q

what is stress incontinence

A

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

22
Q

how are LUTS assessed

A

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

23
Q

what are special investigations to assess LUTS?

A

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

24
Q

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

A

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

25
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
26
who fills out the IPSS
the patient
27
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
28
long voiding time with poor flow indicates?
bladder outflow obstruction (BOO)
29
Q max values indicate what?
<10ml/s = BOO >15ml/s = normal
30
post voiding residual volume (PVR) values indicate what?
<100ml = insignificant >200ml = significant
31
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
32
which patients undergo urodynamic assessment?
those with complex voiding patterns or suspected neurological underlying abnormalities or young patients with severe symptoms