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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 in abdomen
  • lower half in 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
  • uteropelvic junction
  • pelvic brim (crossing through iliac vessels)
  • passing through the bladder wall (uretero-vesical junction)
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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 artery
- internal iliac artery
- 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: detrusor muscle
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 external urethral meatus in the vaginal vestibule

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18
Q

Describe the structure of the urethra at the exterior?

A
  • external urethral sphincter
  • skeletal muscle
  • voluntary control
  • controlledby pudendal nerve
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19
Q

What is the female blood supply of the urethra?

A
  • internal pudenal arteries
  • inferior vesicle branches of the vaginal arteries
  • corresponding venous drainage
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20
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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21
Q

What is the nerve supply of the female urethra?

A
  • vesical plexus
  • pudendeal nerve
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22
Q

What anatomy is part of the male genitourinary system?

A
  • 2 kidneys
  • 2 ureters
  • urinary bladder
  • prostate
  • urethra
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23
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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24
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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25
Q

Where is the prostate?

A
  • lies below the bladder
  • surrounds the proximal part of the urethra
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26
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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27
Q

What are the 3 parts of the male urethra?

A
  • prostatic
  • membranous
  • spongy
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28
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)

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29
Q

What is the lymphatics of the male urethra?

A
  • prostatic and membranous: obturator and internal iliac nodes
  • spongy: deep and superficial inguinal nodes
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30
Q

What is the nerve supply of the male urethra?

A
  • vesical plexus proximally
  • pudendal nerve distally
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31
Q

What is a normal micturition cycle?

A

intermittent storage and voiding of urine in the bladder

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32
Q

What is the filling phase?

A
  • bladder fills and distends without rise in the intravesical pressure
  • urethral sphincter contracts and closes urethra
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33
Q

What is the voiding phase?

A
  • bladder contracts and expels urine
  • urethral sphincter relaxes and urethra opens
34
Q

How is micturition initiated in infants?

A

local spine reflex in which the bladder empties on reaching a critical pressure

35
Q

How is micturition initiated in adults?

A

can be initiated or inhibited by high centre control of the external urethral sphincter keeping it closed until it is appropriate to urinate

36
Q

What innervates the external sphincter?

A

the somatic motor fibre of the pudendal nerve

37
Q

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

A
  • detrusor M3 receptors
  • parasympathetic S2-S4
38
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
39
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
40
Q

What is stress urinary incontinence?

A

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

41
Q

What is the prevalence of stress urinary incontinence?

A
  • 40% of women
  • common with age
  • 1/5 women >40
42
Q

What are the risk factors of stress urinary incontinence?

A
  • ageing
  • obesity
  • smoking
  • pregnancy and route of delivery
43
Q

What is the pathology of stress urinary incontinence?

A

impaired bladder and urethral support and impaired urethral closure

44
Q

What are the signs/symptoms of stress urinary incontinence?

A

involuntary leakage from urethra with exertion/sneezing/coughing

45
Q

What are the investigations for stress urinary incontinence?

A
  • Hx and examination
  • positive stress test (demonstrable loss of urine on examination)
  • Urodynamics
46
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

47
Q

What is the management of stress urinary incontinence?

A
  • physiotherapy with pelvic floor exercises
  • surgical: mid urethral sling, colposuspension and periurethral bulking injection
48
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)
49
Q

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

A

16.6% in the overall population

50
Q

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

A
  • age
  • prolapse
  • increased BMI
  • IBS
  • bladder irritants (nicotine, coffee)
51
Q

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

A
  • involuntary detrusor muscle contraction
  • idiopathic
  • neurogenic
  • bladder outlet obstruction
52
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 in males
  • prolapse in females
53
Q

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

A
  • exclude infection with urine dip
  • voiding diaries
  • assess post void residual with scan
  • urodynamics
  • cystoscopy
54
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
55
Q

What is the definition of benign prostatic hyperplasia?

A

non-malignant growth or hyperplasia of prostate tissue

56
Q

What is the incidence of benign prostatic hyperplasia?

A
  • increases with advancing age
  • 50-60% for 60
  • 80-90% in >70
57
Q

What are the risk factors fo benign prostatic hyperplasia?

A

hormonal effects of testosterone on prostate tissue

58
Q

What is the pathology of benign prostatic hyperplasia?

A
  • hyperplasia of both lateral lobes and median lobe
  • enlarged prostate leads to compression of the urethra
  • bladder outflow obstruction
  • hyperplasia of the stroma
59
Q

What are the signs/symptoms of benign prostatic hyperplasia?

A
  • hesitancy starting urination
  • poor stream
  • dribbling post micturition
  • frequency, nocturia
  • acute retention
60
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
61
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
  • ultrasound to assess renal tracts
  • flow studies/urodynamics
  • cystoscopy
62
Q

What bloods should be done to confirm benign prostatic hyperplasia?

A

PSA - prostatic specific antigen (predict prostate volume)

- if cancer suspected

63
Q

What is the lifestyle management of benign prostatic hyperplasia?

A
  • weight loss
  • reduce caffeine
  • reduce fluid intake in the evening
  • avoid constipation
64
Q

What is the medical management of benign prostatic hyperplasia?

A
  • alpha blocker
  • 5-alpha reductase inhibitor
65
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
66
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
67
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
68
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
69
Q

Where are the hila of the kidneys?

A

L1

70
Q

Are the kidneys intraperitoneal or retroperitoneal?

A

Retroperitoneal

71
Q

What are some variations in kidney anatomy?

A
  • single kidney
  • horseshoe kidney
  • ectopic kidney
  • pelvic kidney
72
Q

What are the variations in ureter anatomy?

A

Partial or complete duplication

73
Q

What is the neural control of micturition?

A
  • Prefrontal cortex permits the pontine micturition centre in the brainstem to change from storage mode to voiding
  • activates the parasympathetic nucleus (bladder contraction), and inhibits Onuf’s nucleus (sphincter relaxation)
74
Q

What is the storage phase?

A
  • bladder relaxed, serves as resevoir
  • outlet contracted, preventing leaks
75
Q

What is the role of the periaqueductal gray (PAG)?

A
  • receives sensory information from viscera
  • decides what goes to cortex for conscious sensation
76
Q

What is the role of the frontal cortex in micturition?

A
  • decision making
  • planning
  • social appropriateness
77
Q

What is the role of the pontine micturition centre (PMC)?

A
  • coordinates spinal centres
  • controls switch from storage to voiding
78
Q

Where is the sympathetic nucleus to the bladder neck?

A

T10-L2

79
Q

Where are the parasympathetic nucleus of the detrusor and onuf’s nucleus of the sphincter?

A

S2-S4

80
Q

What is the nerve supply of the penis and vaginal vestibule/penis?

A

Pudendal nerve

81
Q

What is the nerve supply of the kidney, testicles and bladder neck?

A

Sympathetic nervous system

BRS YR2 (67 decks)

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