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ESA3 > Urinary 9 - Micturition + Incontinence > Flashcards

Urinary 9 - Micturition + Incontinence Flashcards

1
Q

What type of muscle forms the internal urethral sphincter?

A

Smooth muscle

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2
Q

What type of muscle forms the external urethral sphincter?

A

Skeletal muscle

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3
Q

Which urethral sphincter is formed of smooth muscle?

A

Internal urethral sphincter

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4
Q

Which urethral sphincter is formed of skeletal muscle?

A

External urethral sphincter

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5
Q

Name the area of the bladder wall which doesn’t have rugae present:

A

Trigone

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6
Q

Name the 4 layers of the bladder wall:

A

1) Urothelium + Mucosa
2) Submucosa + Lamina propria
3) Muscular
4) Serous visceral peritoneum

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7
Q

What is the outermost layer of the bladder wall?

A

Serous visceral peritoneum

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8
Q

Describe the innermost layer of the bladder wall:

A

Urothelium (transitional epihelium) and mucosa form RUGAE
= Allows distension of bladder without increasing pressure
(Rugae not present in trigone area)

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9
Q

Describe the muscular layer of a bladder wall:

A

Detrusor muscle has 3 layers:

  • Outermost = longitudinal
  • Middle = circular
  • Innermost = longitudinal
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10
Q

Why does the detrusor muscle have criss-crossed layers?

A

To provide strength from every direction when stretched

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11
Q

Which nerves innervate the external urethral sphincter, and what is their function?

A

Somatic Pudendal nerves (S2-4)

= Contracts external sphincter

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12
Q

Which nerves innervate the internal urethral sphincter, and what is their function?

A

Sympathetic T11-L2

= Contracts internal sphincter

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13
Q

What are the nerve roots of the sympathetic nerves which innervate the bladder and internal urethral sphincter?

A

T11 - L2

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14
Q

What are the nerve roots of the sensory nerves detecting bladder stretch?

A

S2, S3, S4 Keeps the bladder off the floor

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15
Q

What reaction is caused by a low sensory input from the bladder?

A

Sensory fibres synapse with sympathetic nerves (T11-L2),

= Relaxation of detrusor muscle and contraction of internal urethral sphincter

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16
Q

What reaction is caused by a high sensory input from the bladder?

A

Sensory nerves synapse parasympathetic fibres (S2-4)
= Contraction of detrusor muscle
Sensory nerves synapse M center, which:
Inhibits L center = Allows relaxation of internal and external sphincters

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17
Q

Which pontine continence center facilitates micturition?

A

M (medial) center

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18
Q

Which pontine continence center factilitates urine storage?

A

L (lateral) center

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19
Q

What type of receptors are present in the bladder wall, and respond to Ach?

A

M2-3

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20
Q

Name the 2 pontine continence centers, and their main functions:

A

1) L (lateral) - facilitates urine storage

2) M (medial) - facilitates micturition

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21
Q

At what volume of fluid in the bladder do you become aware (of fluid in the bladder)?

A

~ 150 ml

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22
Q

What structures prevent retrograde ejaculation into the bladder?

A
  • Internal urethral sphincter

- Prostatic urethra

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23
Q

Define incontinence:

A

The complaint of any involuntary leakage of urine

24
Q

List some symptoms of problems with urine storage:

A
  • Nocturia
  • Increased frequency
  • Incontinence
  • Urgency
25
Q

List some symptoms of problems with micturition:

A
  • Pain
  • Hesitancy
  • Intermittency
  • Slow stream
  • Spitting/spraying
  • Straining
  • Terminal dribble
26
Q

List some symptoms of problems post-micturition:

A
  • Post-micturition dribble

- Feeling of incomplete emptying

27
Q

List some causes of temporary urinary incontinence:

A
  • UTI
  • Constipation
  • Alcohol
  • Caffeine
  • Artificial sweeteners
  • Foods high in sugar/spice/acid
28
Q

List some causes of persistent urinary incontinence:

A
  • Pregnancy
  • Childbirth
  • Hysterectomy
  • Enlarged prostate
  • Prostatic cancer
  • Age
  • Obstruction: Tumour/Stone
  • Neurological disorder (MS, parkinson’s, stroke, tumour, spinal injury)
29
Q

How would a lower motor neuron lesion (S2-4) affect micturition?

A

Decreased detrusor pressure = large residual urine volume = overflow incontinence

30
Q

How would an upper motor neuron lesion affect micturition?

A

Increased contractions of detrusor causing increased detrusor pressure (poor coordination with sphincters)
= micturition as soon as urine present

31
Q

Name the 4 classifications of urinary incontinence:

A

1) Urge incontinence
2) Overflow incontinence
3) Stress incontinence
4) Mixed incontinence

32
Q

What is the most common type of incontinence (~47%)?

A

Stress urinary incontinence

33
Q

Describe stress urinary incontinence:

A

Complaint of involuntary urine leakage on exertion or effort, or sneezing/coughing

34
Q

Describe urge urinary incontinence:

A

Complaint of involuntary urine leakage, immediately preceded by urgency

35
Q

Describe mixed urinary incontinence:

A

Complaint of involuntary urine leakage with urgency and also on effort/exertion/sneezing/coughing

36
Q

Describe overflow incontinence:

A

Complaint of frequent involuntary urine leakage due to inability to completely empty bladder

37
Q

Name the main 3 symptoms of Overactive Bladder Syndrome (OABS):

A

1) Nocturia
2) Increased frequency
3) Urgency

38
Q

What name is given to describe the symptom of involuntary urine leakage when coughing/sneezing?

A

Stress urinary incontinence

39
Q

What name is given to describe the symptom of involuntary urine leakage immediately preceded by urgency?

A

Urge urinary incontinence

40
Q

What types of examination may a doctor do if patient presents with incontinence?

A
  • BMI check
  • Abdominal exam (palpate bladder)
  • Digital rectal exam (Males)
  • External genitalia stress test (Females)
41
Q

What is most important investigation that should always be done if a patient presents with incontinence?

A

Urine dipstick test

= Check for UTI, haematuria, proteinuria, glucosuria

42
Q

List some investigations which may be performed on a patient presenting with incontinence:

A
  • Urine dipstick
  • Non-invasive urodynamics (Freq/V chart, Bladder diary > 3 days
  • Invasive urodynamics (pressure/flow studies)
  • Pad tests
  • Cytoscopy
43
Q

Describe the initial management of a patient with stress urinary incontinence:

A
  • Pelvic floor exercises
  • Modify water intake
  • Weight loss
  • Stop smoking
  • Decrease alcohol/caffeine intake
44
Q

Describe the initial management of a patient with urge urinary incontinence:

A
  • Bladder training (timed voiding)
  • Weight loss
  • Modify water intake
  • Stop smoking
  • Decrease alcohol/caffeine intake
45
Q

If patient with incontinence has failed initial management, and is unsuitable for surgery, what are the other management options?

A
  • Indwelling catheter
  • Sheath device
  • Incontinence pads
  • Drugs
46
Q

What drug is used to treat stress urinary incontinence, and how does it work?

A

Duloxetine

- Combined NA and Serotonin uptake inhibitor = increased activity in external sphincter during filling phase

47
Q

What drugs are used to treat urge urinary incontinence?

A

1) Anticholinergics ie Oxybutynin
2) B3 adrenoceptor agonist ie Mirabegron
3) Botulinum toxin

48
Q

Give an example of an anticholinergic drug used to treat urge urinary incontinence, and give the advantages and disadvantages of use:

A

Oxybutynin
Adv = Cheap
Disadv = Side effects: Dry mouth, nausea, increased heart rate, mental/mood changes

49
Q

Give an example of a B3 adrenoceptor agonist drug used to treat urge urinary incontinence, and how it works:

A

Mirabegron

= Increases bladder capacity as allows bladder relaxation

50
Q

How is botulinum toxin used to treat urge urinary incontinence?

A

Injected into detrusor muscle, inhibiting Ach release = partial paralysis, allowing bladder to fill without stimulating micturition
Lasts 3-6 months

51
Q

What is the main side effect of paralysing the bladder with botulinum toxin?

A

Increased risk of UTIs

52
Q

Give the 4 possible surgical managements for a female with stress urinary incontinence:

A

1) Low-tension vaginal tapes
2) Open retropubic suspension procedure
3) Classical fascial sling procedure
4) Intramural bulking agent

53
Q

Which surgical management of stress urinary incontinence would allow a female to have further pregnancies? (Is temporary)

A

Intramural bulking agents

54
Q

What is the surgical management available to men with stress urinary incontinence? How does it work?

A

Artificial urinary sphincter

Hydraulic cuff stimulates action of normal sphincter

55
Q

Give the 4 possible surgical managements for a patient with urge urinary incontinence:

A

1) Sacral nerve neuromodulation
2) Autoaugmentation
3) Autoaugmentation cystoplasty
4) Urinary diversion

ESA3 (48 decks)

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