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Urology and Renal Medicine > Urinary Incontinence and Benign Prostatic Hyperplasia > Flashcards

Urinary Incontinence and Benign Prostatic Hyperplasia Flashcards

1
Q

embryology of the prostate

A

between 10-16 weeks of gestation from epithelial buds which branch out from the posterior aspect of the urogenital sinus to invade the mesenchyme

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2
Q

main influencing hormone of the prostate

A

dihydrotestosterone

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3
Q

arterial blood supply of the prostate

A

branches of inferior vesical artery > prostatic artery > urethral + capsular groups of arteries > urethral group give rise to Flock’s + Badenoch’s arteries

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4
Q

venous drainage of the prostate

A

via peri-prostatic venous plexus > drains into internal iliac vein

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5
Q

lymph drainage of the prostate

A

to the obturator nodes and then the internal iliac chain

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6
Q

list the McNeal’s zones

A

transition
central
peripheral

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7
Q

transition zone

A

10% of the glandular tissue of the prostate

site of origin of benign prostate hyperplasia

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8
Q

peripheral zone

A

65% of the glandular tissue of the prostate

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9
Q

central zone

A

25% of the glandular tissue

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10
Q

benign prostatic hyperplasia

A 
prostatism (lower urinary tract symptoms)
benign prostatic enlargement
benign prostatic hyperplasia
bladder outflow obstruction
benign prostatic obstruction
benign prostatic hypertrophy
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11
Q

describe benign prostate hyperplasia

A

increase in number of epithelial and stromal cells in peri urethral area of the prostate in response to androgens (testosterone) and growth factors

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12
Q

bladder changes in BPH

A

decreased urinary flow

urinary frequency, urgency, nocturia

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13
Q

function of the prostate

A

liquefy ejaculate

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14
Q

pathophysiology of BPH

A

enlarged prostate > increased urethral resistance > compensatory changes in bladder fx

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15
Q

in regards to BPH, what change is required to maintain urinary flow?

A

increased detrusor pressure

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16
Q

the ______ transmits the ‘pressure’ of tissue expansion to the urethra

A

capsule

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17
Q

is the size of the prostate equal to the degree of the obstruction?

A

no

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18
Q

what is the most abundant adrenoreceptor subtype in the human prostate?

A

alpha1A

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19
Q

are lower urinary tract symptoms in men with BPH related to obstruction induced changes in bladder function or direct outflow obstruction?

A

obstruction induced changes in bladder function

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20
Q

list obstruction induced changes

A

detrusor instability/decreased compliance > frequency /urgency
decreased detrusor contractility > hesitancy, intermittency, increased residual urine, detrusor failure

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21
Q

symptoms of benign prostatic hyperplasia

A

voiding: reduced flow, hesitancy, incomplete emptying, strangury
storage: frequency (day/night), urgency, incontinence
other: infection, visible haematuria

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22
Q

examination for BPH includes?

A 
general (ask about fluid intake)
palpable bladder
ballotable kidneys
phimosis
meatal stenosis
enlarged prostate on DRE, size, consistency, nodules, anal tone, sensation
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23
Q

investigations for BPH includes?

A 
urine dipstick
flow rate + PVR
IPSS questionnaire
bladder diary
PSA, creatinine
flexible cytoscopy
USS KUB
TRUS prostate
urodynamic studies
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24
Q

management of benign prostate hyperplasia

A

watchful waiting
lifestyle changes
pharmacological treatment
surgery

25
Q

list pharmacological treatment options for BPH

A

alpha adrenergic antagonists
5-alpha reductase inhibitors
combination therapy

26
Q

list examples of alpha adrenergic antagonists

A

tamsulosin
alfuzosin
doxazosin

27
Q

list examples of 5-alpha reductase inhibitors

A

finasteride

dustasteride

28
Q

alpha adrenergic antagonists are used to?

A

reduce symptoms

improve flow rate

29
Q

5-alpha reductase inhibitors are used to?

A

prevent disease progression

reduce development of AUR/requirement for surgery

30
Q

list surgical treatment options for BPH

A 
TURP
Rezum
UroLIFT
Millin's prostatectomy
embolisation
HoLEP
31
Q

what is urine incontinence?

A

complaint of any involuntary loss of urine

32
Q

list types of urine incontinence

A 
stress incontinence
urge incontinence
mixed urinary incontinence
continuous incontinence
overflow incontinence
nocturnal enuresis
post-micturition dribble
33
Q

what is stress incontinence?

A

the complaint of involuntary leakage on exertion /sneezing/coughing

34
Q

what is urge incontinence?

A

the complaint of an involuntary leakage accompanied by or immediately preceded by urgency

35
Q

what is mixed urinary incontinence?

A

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

36
Q

what is continuous incontinence?

A

continuous leakage

37
Q

what is overflow incontinence?

A

leakage associated with urinary retention

38
Q

what is nocturnal enuresis?

A

the complaint of loss of urine occurring during sleep

39
Q

what is micturition dribble?

A

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

40
Q

risk factors for urine incontinence

A 
increasing age
pregnancy and vaginal delivery
obesity
constipation
drugs e.g. ACE inhibitors
smoking
family hx
prolapse/hysterectomy/menopause
41
Q

investigations for urine incontinence

A 
urine dipstick
flow rate + post-void/residual
Bladder diary
Pad tests
Patient symptom scores/validated QoL questionnaire
Urodynamic/video-urodynamic studies
42
Q

stress urinary incontinence is more common in?

A

women of young to middle age

43
Q

stress urinary incontinence is uncommon in?

A

men who have not had prostate surgery

44
Q

list 5 causative theories of stress incontinence in women

A 
urethral position theory
intrinsic sphincter deficiency
integral theory
hammock theory
trampoline theory
45
Q

non-surgical treatments for stress urinary incontinence in men and women

A

supervised pelvic floor exercises
bladder re-training
lifestyle changes: weight loss, cessation of smoking, modification of high/low fluid intake

46
Q

pharmacological treatment for stress urinary incontinence in women

A

oestrogen therapy is evidence of atrophy

oral medical therapy in rare cases

47
Q

surgical treatments for stress urinary incontinence in women

A

occlusive e.g. bulking, compressive (AUS)
supportive (midurethral sling, colposuspension)
ileal conduit diversion

48
Q

list 3 causative theories for stress incontinence in men

A

sphincter incompetence
reduction in urethral sphincter length
post-operative strictures

49
Q

list structures that control continence

A 
detrusor muscle
internal sphincter
ureterotrigonal muscles
levator muscles
rhabidosphincter (external sphincter)
50
Q

pharmacological treatment for stress urinary incontinence in men

A

oral medical therapy in rare cases

51
Q

surgical treatments for stress urinary incontinence in men

A

Occlusive e.g. bulking, compressive (AUS)
Supportive (suburethral sling)
Ileal conduit diversion

52
Q

what is overactive bladder?

A

symptom syndrome: urinary frequency, urgency, nocturia with or without leak

53
Q

prevalence of overactive bladder

A

16% in men and women

54
Q

men have a higher prevalence in what type of overactive bladder?

A

OAB-dry

55
Q

women have a higher prevalence in what type of overactive bladder?

A

OAB-wet

56
Q

differential diagnosis for urge urinary incontinence

A 
UTI
DO
Urethral syndrome
Urethral divertivulum
Interstitial cystitis
Bladder cancer
Large residual volume
57
Q

management for urge urinary incontinence

A

lifestyle changes: decrease caffeine, smoking cessation, weight loss
bladder retraining
pelvic floor muscle exercise
pharmacotherapy

58
Q

list examples of pharmacotherapy for urge urinary incontinence

A

anti-cholinergics e.g. e.g. solifenacin, tolterodine, trospium
beta-3-agonists e.g. betmiga

59
Q

surgical treatment for urge urinary incontinence

A

Posterior tibial nerve stimulation (PTNS)
Intravesical injection of botulinum toxin A
Neuromodulation
Clam (augmentation) cystoplasty
Urinary diversion is an option if all else fails in very severe cases

Urology and Renal Medicine (8 decks)

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