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Year 2 Uro > Urinary Incontinence > Flashcards

Urinary Incontinence Flashcards

1
Q

What is BPH?

A

Benign Prostatic Hyperplasia

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2
Q

What is the main influencing hormone for prostate developement?

A

dihydrotestosterone

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3
Q

What are the three zones?

A

Transition: 10% of the glandular tissue of the prostate
Site of origin of benign prostatic hyperplasia

Central: 25% of the glandular tissue of the prostate

Peripheral: 65% of the glandular tissue of the prostate

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4
Q

What is the function of the prostate?

A

Liquefy ejaculate

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5
Q

What is the role of the capsule?

A

The capsule transmits the ‘pressure’ of tissue expansion to the urethra and leads to an increase in urethral resistance

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6
Q

How is active smooth muscle tone regulated?

A

by the adrenergic nervous system

⍺1A adrenoreceptor is most abundant in prostate

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7
Q

What is LUTS in men with BPH related to?

A

Obstruction induced changes, changes in bladder function rather than to outflow obstruction directly.

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8
Q

What are the two classes of symptoms of BPH?

A

Voiding

Storage

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9
Q

What is important to ask about in BPH?

A

Fluid intake

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10
Q

What comprised the BPH examination?

A 
General examination
Palpable bladder
Ballotable kidneys
Phimosis
Meatal stenosis
Enlarged prostate on DRE, size, consistency, nodules, anal tone and sensation
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11
Q

What are obstruction-induced changes?

A

Detrusor instability/↓ compliance → frequency and urgency

↓ detrusor contractility → 
Further deterioration in the force of the urinary stream 
Intermittency
Increased residual urine
Sometimes detrusor failure
Hesitancy
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12
Q

What are voiding symptoms?

A

Reduced flow
Incomplete emptying
Strangury
Hesitancy

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13
Q

What are storage symptoms?

A

Frequency (daytime and nocturia)
Urgency
Incontinence

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14
Q

What are other symptoms seen in BPH?

A

Visible haematuria

Infection

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15
Q

What investigations are done for BPH?

A 
Urine dipstick
Bladder diary
Flow rate + PVR
IPSS Questionnaire 
PSA, creatinine
Flexible cystoscopy in some circumstances
TRUS prostate
Urodynamic studies

USS KUB if impaired renal function, loin pain, haematuria, renal mass on examination

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16
Q

What is a IPSS?

A

Validated patient reported outcome measures

Specifically designed for BPH

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17
Q

What is a bladder diary?

A

Record when and how much fluid

Record volume of urine passed and when

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18
Q

What are the management options for BPH?

A

Watch and wait
Lifestyle changes
Pharmacological treatment
Surgical

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19
Q

What lifestyle changes can be made for BPH

A 
What they drink
How much they drink
Tweaks to improve urinary symptoms 
e.g. stop drinking late at night to limit passing urine at night 
cut out caffeine
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20
Q

What are some 5-alpha-reductase inhibitors?

A

e.g. Finasteride, Dustasteride

to prevent disease progression, reducing the development of AUR/requirement for surgery

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21
Q

What are some alpha-adrenergic antagonists?

A

e.g. Tamsulosin, alfuzosin, doxazosin

reduction in symptoms of 30-40% and improvement in flow rates of 16-25%

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22
Q

What are the surgical options for BPH?

A

TURP - transurethral resection of prostate

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23
Q

What is urinary incontinence?

A

significant health problem worldwide associated with considerable social and economic impact on individuals and society

24
Q

Describe the epidemiology of UI?

A

In women, prevalence 5-72% among community-dwelling women

It may be significantly under-reported as it is an embarrassing problem to many women

Women with SI are less likely to seek help than those with OAB

25
Q

What is stress UI?

A

the complaint of involuntary leakage on exertion/sneezing/coughing/pregnancy

increased intraabdominal pressure overwhelms sphincter muscles and allows urine to leak out

26
Q

What is urge UI?

A

the complaint of an involuntary leakage accompanied by or immediately preceded by urgency
especially at night
usually uninhibited detrusor muscle

27
Q

What is mixed UI?

A

the complaint of an involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing

28
Q

What is continuous incontinence?

A

continuous leakage

29
Q

What is overflow incontinence?

A

leakage associated with urinary retention

blockage in urine flow (BPH) or ineffective detrusor

can cause weak/intermittent flow or hesitancy

30
Q

What is nocturnal enuresis?

A

the complaint of loss of urine occurring during sleep

31
Q

What is Post-micturition dribble?

A

the complain of an involuntary loss of urine immediately after passing urine

32
Q

What are risk factors for UI?

A 
Age
Pregnancy and vaginal birth
Obesity
Constipation
Drugs e.g. ACE inhibitors
Smoking
FHx
Prolapse/Hysterectomy/Menopause
33
Q

What investigations are done for UI?

A 
Urine dipstick
Flow rate and post-void residual
Bladder diary
Pad tests
Patient symptom scores/validated QoL questionnaire
Urodynamic/video-urodynamic studies
34
Q

What are the lifestyle changes for SI in women?

A 
Weight loss 
Smoking cessation
Modification of high/low fluid intake
Supervised pelvic floor exercises
Bladder re-training
35
Q

What are the possible pharmacological treatments for SI?

A

Oestrogen therapy if there is evidence of atrophy

Oral medical therapy in rare cases

36
Q

What are the surgical options for SI?

A

Occlusive e.g. bulking, compressive (AUS)
Supportive (mid-urethral sling, colposuspension)
Ileal conduit diversion

37
Q

What are the three causative theories of SI in men?

A

Sphincter incompetence
Reduction in urethral sphincter length
Post-operative strictures

38
Q

What are the 5 structures that control continence?

A 
Detrusor muscle
Internal sphincter
Ureterotrigonal muscles
Levator muscles
Rhabdosphincter (external sphincter muscle)
39
Q

What is OAB?

A

Over-active bladder

Symptom syndrome

40
Q

What symptoms comprise overactive bladder?

A

Urinary frequency
Urgency
Nocturia with or without leak

41
Q

What are differentials surrounding UUI?

A 
UTI
DO
Urethral syndrome
Urethral divertivulum
Interstitial cystitis
Bladder cancer
Large residual volume
42
Q

What are lifestyle changes for UUI?

A

decreasing caffeine intake
stopping smoking
losing weight if obese

43
Q

What pharmacotherapy can be used for UUI?

A

Efficacy is 50-75%
Anti-cholinergics e.g. solifenacin, tolterodine, trospium
Beta-3-agonists e.g. betmiga

44
Q

What are the surgical options for UUI?

A

Posterior tibial nerve stimulation

Intravesical injection of botulinum toxin A

Neuromodulation

Clam (augmentation) cystoplasty

Urinary diversion

45
Q

What is the efficacy for botox injections?

A

efficacy is 36-89%, mean efficacy is 70%, upto a mean time of 6 months

46
Q

What is the efficacy for neuromodulation in UI treatment?

A

50% cure rate, 25% significant improvement of symptoms, 25% failure rate

47
Q

What is the efficacy of clam cystoplasty?

A

50% cure rate, 25% significant improvement of symptoms, 25% failure rate

48
Q

medical treatments of BPH

A

alpha blockers - symptom relief (relax bladder neck)

5a reductase inhibitors (prevents test-DHT so results in shrinkage improving obstructive symptoms)

49
Q

what is functional UI?

A

severe congitive impairment of mobility limitations preventing use of toilet
bladder function normal

50
Q

phases of micturition

A

filling phase - bladder fills/distends wtihout rise in intravesical pressure. urethral sphincter contracts and closes urethra

voiding phase - bladder contracts and expels urine, urethral sphincter relaxes and urethra opens

51
Q

what is in control of external urethral sphincter

A

pudendal nerve S2-4

voluntary control in adults

52
Q

process of micturition

A

M3 receptors stimulated by full bladder (parasympathetic)
contraction of detrusor muscle by parasympathetic S2-4, inhibits internal urethral sphincter for bladder emptying

voluntary pudendal nerve (S2-4) relaxation of external urethral sphincter

once empty, sympathetic fibres (T11-L2) stimulated to activate beta-3 receptors to cause relaxation of detrusor muscle

53
Q

lymphatic drainage of female ureters

A

left - paraaortic

right - paracaval and interaortocaval

54
Q

anatomical constrictions of ureters

A

pelvic uteric junction
pelvic brim
as it passes through bladder wall

55
Q

blood supply of bladder

A

superior and inferior vesical branches of internal iliac artery
female drainage by vesical plexus - internal iliac vein
male drainage by prostatic plexus - internal iliac vein

Year 2 Uro (5 decks)

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