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BRS YR2 > Urinary Incontinence and Benign Prostatic Hyperplasia > Flashcards

Urinary Incontinence and Benign Prostatic Hyperplasia Flashcards

1
Q

What is the function of the kidneys?

A
  • removes waste products of metabolism
  • excess water and salts from the blood
  • maintain the pH
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2
Q

What anatomy is part of the female genitourinary system?

A
  • 2 kidneys
  • 2 ureters
  • urinary bladder
  • urethra
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3
Q

What is the function of the ureters?

A

convey urine from the kidneys to the urinary bladder

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4
Q

Where does the ureter lie?

A

upper half - abdomen

lower half - pelvis

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5
Q

What is the average dimensions of the ureters?

A
  • 3mm in diameter

- 25cm long

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6
Q

Where is the ureter slightly constricted?

A
  • pelvic ureteric junction
  • pelvic brim
  • passing through the bladder wall
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7
Q

What are the 3 layers of tissue in the ureter?

A
  • outer fibrous tissue
  • middle muscle layer
  • inner epithelium layer
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8
Q

What is the blood supply of the ureter?

A 
related to region:
- renal/lumbar/gonadal/common iliac 
- internal iliac 
- superior vesical arteries
(corresponding venous drainage)
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9
Q

What are the lymphatic management of the ureters?

A 
Left ureter:
- left para-aortic nodes
Right ureter:
- right paracaval
- interaortocaval lymph nodes
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10
Q

What is the nerve supply of the ureter?

A

autonomic nervous system

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11
Q

What is the bladder?

A

a muscular reservoir of urine

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12
Q

Where is the bladder located?

A

empty: pelvic
full: abdomino-pelvic

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13
Q

What are the layers of the bladder?

A

outer: loose connective tissue
middle: smooth muscle and elastic fibres
inner: transitional epithelium

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14
Q

What is the blood supply of the bladder?

A
  • superior and inferior vesical branches of the internal iliac
  • drained by the vesical plexus which drains into the internal iliac vein
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15
Q

What is the lymphatics of the bladder?

A
  • internal iliac nodes

- para-aortic nodes

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16
Q

What is the nerve supply of the bladder?

A

autonomic nervous system

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17
Q

What is the female urethra?

A

channel from the neck of the bladder to the exterior (at the external urethral orifice)

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18
Q

Describe the structure of the urethra at the neck of the bladder?

A
  • internal urethral sphincter
  • thickened detrusor muscle
  • smooth muscle
  • involuntary control
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19
Q

Describe the structure of the urethra at the exterior?

A
  • external urethral sphincter
  • skeletal muscle
  • voluntary control
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20
Q

What is the female blood supply of the urethra?

A
  • internal pudenal arteries

- inferior vesicle branches of the vaginal arteries

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21
Q

What is the lymphatic system of the female urethra?

A
  • proximal urethra into internal iliac nodes

- distal urethra into the superficial inguinal lymphnodes

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22
Q

What is the nerve supply of the female urethra?

A
  • vesical plexus

- pudendeal nerve

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23
Q

What anatomy is part of the male genitourinary system?

A
  • 2 kidneys
  • 2 ureters
  • urinary bladder
  • prostate
  • urethra
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24
Q

What is the venous drainage of the bladder in males?

A

prostatic venous plexus which drains into the internal iliac vein

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25
Q

What is the function of the prostate?

A

secrete 75% of seminal fluid which liquifies coagulated semen after deposition in the female genital tract

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26
Q

Where is the prostate?

A
  • lies below the bladder

- surrounds the proximal part of the urethra

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27
Q

What are the 3 parts of the prostate?

A
  • left lateral lobe
  • right lateral lobe
  • middle lobe
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28
Q

What is the blood supply of the prostate?

A
  • inferior vesicle artery

- venous drainage: prostatic plexus to the vesical plexus and the internal iliac vein

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29
Q

What are the lymphatics of the prostate?

A

internal and sacral nodes

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30
Q

What are the nerve supply of the prostate?

A

autonomic nervous system

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31
Q

Where is the urethra in males?

A

through:

  • neck of the bladder
  • prostate gland
  • floor of the pelvis
  • perineal membrane
  • penis
  • external urethral orifice
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32
Q

What are the 3 parts of the male urethra?

A
  • prostatic
  • membranous
  • spongy
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33
Q

What is the blood supply of the male urethra?

A

prostatic: inferior vesical artery
membranous: bulbourethral artery
spongy: internal pudenal artery
(corresponding venous drainage)

34
Q

What is the lymphatics of the male urethra?

A

prostatic and membranous: obturator and internal iliac nodes

spongy: deep and superficial inguinal nodes

35
Q

What is the nerve supply of the male urethra?

A

prostatic plexus

36
Q

What is normal micturition?

A

intermittent voiding of urine stored in the bladder

37
Q

What is the filling phase?

A
  • bladder fills and distends without rise in the intravesical pressure
  • urethral sphincter contracts and closes urethra
38
Q

What is the voiding phase?

A
  • bladder contracts and expels urine

- urethral sphincter relaxes and urethra opens

39
Q

How is micturition initiated in infants?

A
  • local spine reflex in which the bladder empties on reaching a critical pressure
40
Q

How is micturition initiated in adults?

A
  • can be initiated or inhabited by high centre control of the external urethral sphincter keeping it closed until it is appropriate to urinate
41
Q

What innervates the external sphincter?

A

the somatic motor fibre of the pudendal nerve

42
Q

What receptors/sensory nerves are stimulated as the bladder fills?

A
  • M3 receptors

- parasympathetic S2-S4

43
Q

What happens when the M3 receptors are stimulated?

A
  • contraction of the detrusor muscle for urination

- inhibition of the internal urethral sphincter which causes relaxation and allows for bladder emptying

44
Q

What happens when the bladder empties?

A
  • stretch fibres are inactivated
  • sympathetic nervous system (T11-L2) activates the beta 3 receptors causing relaxation of the detrusor muscle allowing for bladder filling
45
Q

What is stress urinary incontinence?

A

complaint of involuntary leakage on effort or exertion, or on sneezing or coughing

46
Q

What is the prevalence of stress urinary incontinence?

A
  • 40% of women
  • common with age
  • 1/5 women >40
47
Q

What are the risk factors of stress urinary incontinence?

A
  • ageing
  • obesity
  • smoking
  • pregnancy
  • route of delivery
48
Q

What is the pathology of stress urinary incontinence?

A

impaired bladder and urethral support and impaired urethral closure

49
Q

What are the signs/symptoms of stress urinary incontinence?

A

involuntary leakage from urethra with exertion/sneezing/coughing

50
Q

What are the investigations for stress urinary incontinence?

A
  • Hx and examination
  • positive stress test (demonstrable loss of urine on examination)
  • Urodynamics
51
Q

What would be seen on urodynamics with stress urinary incontinence?

A

urinary leakage during an increase in intra-abdominal pressure in the absence of a detrusor contraction

52
Q

What is the management of stress urinary incontinence?

A
  • non-surgical physio with PFE

- surgical-mid urethral sling, colposuspension and periurethral bulking agents

53
Q

What is an overactive bladder/urge urinary incontinence?

A
  • urinary urgency
  • often with nocturia and urinary frequency
  • with or without urgency urinary incontinence
    (urge to urinate with an empty bladder)
54
Q

What is the prevalence of overactive bladder/urge urinary incontinence?

A

16.6% in the overall population

55
Q

What are the risk factors of overactive bladder/urge urinary incontinence?

A
  • age
  • prolapse
  • increased BMI
  • IBS
  • bladder irritants (nicotine, coffee)
56
Q

What is the pathology of overactive bladder/urge urinary incontinence?

A
  • involuntary detrusor muscle contraction
  • idiopathic
  • neurogenic
  • bladder outlet obstruction
57
Q

What are the signs/symptoms of overactive bladder/urge urinary incontinence?

A
  • urgency
  • frequency
  • nocturia
  • urgency incontinence
  • impact of QOL
  • sleep disorders
  • anxiety
  • depression
  • enlarged prostate
  • prolapse
58
Q

What are the investigations to confirm overactive bladder/urge urinary incontinence?

A
  • exclude infection with urine dip
  • voiding diaries
  • assess post void residual
  • urodynamics
  • cystoscopy
59
Q

What is the management of overactive bladder/urge urinary incontinence?

A
  • behaviour/lifestyle changes
  • bladder retaining
  • anti-musancaric drugs
  • beta-3 agonists
  • BOTOX
  • Neuromodulation (PTNS/SNS)
  • Surgical: augmentation custoplasty and urinary diversion
60
Q

What is overflow incontinence?

A

involuntary leakage of urine when the bladder is full, usually due to chronic retention secondary to obstruction or an atonic bladder

61
Q

What can cause overflow incontinence?

A
  • outlet obstruction (faecal impaction/BPH)
  • underactive detrusor muscle
  • bladder neck stricture
  • urethral stricture
  • DHx - alpha adrenergics, anti-cholinergics and sedatives
  • bladder denervation post surgery
62
Q

What is continuous incontinence?

A

continuous loss of urine at all time

63
Q

What can cause continuous incontinence?

A
  • vesicovaginal fistula

- ectopic ureter (kidney to urethra/vagina)

64
Q

What is functional incontinence?

A
  • due to severe cognitive impairment or mobility limitations
  • prevents use of toilet
  • bladder function is normal
65
Q

What is mixed incontinence?

A
  • more than one type

- seen in older patients

66
Q

What is the definition of benign prostatic hyperplasia?

A

non-malignant growth or hyperplasia of prostate tissue

67
Q

What is the incidence of benign prostatic hyperplasia?

A
  • increases with advancing age
  • 50-60% for 60
  • 80-90% in >70
68
Q

What are the risk factors fo benign prostatic hyperplasia?

A

hormonal effects of testosterone on prostate tissue

69
Q

What is the pathology of benign prostatic hyperplasia?

A
  • hyperplasia of both lateral lobes and the median lobes leading to compression of the urethra
  • bladder outflow obstruction
  • hyperplasia of the stroma (smooth muscle and fibrous tissue) and glands
70
Q

What are the signs/symptoms of benign prostatic hyperplasia?

A
  • hesitancy starting urination
  • poor stream
  • dribbling post micturition
  • frequency, nocturia
  • acute retention
71
Q

What differentials should be excluded when benign prostatic hyperplasia is suspected?

A
  • bladder/prostate cancer
  • cauda equina
  • high pressure chronic retention
  • UTIs, STIs
  • prostatitis
  • neurogenic bladder (MS, Parkinsons)
  • Urinary tract stones
  • Urethral stricture
72
Q

What investigations should be done for benign prostatic hyperplasia?

A
  • abdominal, pelvic and rectal exam
  • urine dip/MCS
  • post void residual
  • voiding diary
  • bloods
  • imaging
  • flow studies/urodynamics
  • cystoscopy
73
Q

What bloods should be done to confirm benign prostatic hyperplasia?

A

PSA - prostatic specific antigen (predict prostate volume)

- if cancer suspected

74
Q

What imaging should be done to confirm benign prostatic hyperplasia?

A

ultrasound

- to assess upper renal tracts

75
Q

What is the lifestyle management of benign prostatic hyperplasia?

A
  • weight loss
  • reduce caffeine
  • reduce fluid intake in the evening
  • avoid constipation
76
Q

What is the medical management of benign prostatic hyperplasia?

A
  • alpha blocker

- 5-alpha reductase inhibitor

77
Q

What is the surgical management of benign prostatic hyperplasia?

A

transurethral resection of the prostate (TURP)

- debulks prostate to produce adequate channel for urine flow

78
Q

Why is an alpha blocker used in the management of benign prostatic hyperplasia?

A

alpha 1-AR present on the prostate stromal smooth muscle and bladder neck
- blockage causes relaxation, improving urinary flow rate

79
Q

Why is a 5-alpha reductase inhibitor used in the management of benign prostatic hyperplasia?

A
  • prevents the conversion of testosterone to DHT (which promotes growth and enlargement of the prostate)
  • causes shrinkage, improving urinary flow rate and obstructive symptoms
80
Q

What are the complications associated with benign prostatic hyperplasia?

A 
progressive bladder distention
- causing painless chronic retention and overflow incontinence
if untreated:
- bilateral upper tract obstruction
- renal impairment
- chronic renal disease

BRS YR2 (70 decks)

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