urinary incontinence and bph Flashcards
what is the urinary bladder
muscular reservoir of urine
what is blood supply to bladder
superior and inferior vesical branches of internal iliac artery. drained by vesical which drains into internal iliac vein
lymphatics of bladder
internal iliac nodes and paraaortic nodes
what is urethra
channel from neck of bladder to external urethral orifice
blood supply of urethra
internal pudendal arteries and inferior vesicle branches of vaginal arteries with corresponding venous drainage
lymphatics of urethra
proximal urethra into internal iliac nodes
distal urethra to superficial inguinal lymph nodes
nerve supply of urethra
vesical plexus and pudendal nerve
blood supply of prostate
inferior vesicle artery
venous drainage via prostatic plexus to vesical plexus and internal iliac vein
lymphatics of prostate
internal and sacral nodes
nerve supply of prostate
autonomic nervous system
what is normal micturition
intermittent voiding of urine stored in bladder
what happens in filling phase of micturition
bladder fills and distends without rise in intravesical pressure. urethral sphincter contracts and closes urethra
what happens in voiding phase of micturition
bladder contracts and expels urine,
urethral spincter relaxes and urethra opens
in adults how can voiding be initiated/ inhabitiated
control of external urethral sphincter keeping it closed until it is appropriate to urinate
innervation of micturition for bladder emptying
m3 receptors (parasympathetic s2-s4) are stimulated as bladder fills. as they become stretched and stimulated this results in contraction of detrusor muscle for urination. at same time parasympathetic fibres inhibit internal urethral sphincter which causes relaxation and allows for bladder emptying
describe innervation of micturition when bladder filling again
when bladder empties urine the stretch fibres become inactivated and sympathetic nervous system (originating from t11-l2) is stimulated to activate beta 3 receptors causing relaxation of detrusor muscle allowing bladder to fill again
what is stress urinary incontinence
complaint of involuntary leakage on effect/exertion or on sneezing/coughing
what are the risk factors for stress urinary incontinence
ageing obesity smoking pregnancy route of delivery
what is the pathology of stress urinary incontinence
impaired bladder and urethral support and impaired urethral closure
what are the signs and symptoms of stress urinary incontinence
involuntary leakage from urethra with exertion/effort on sneezing/coughing
what are the investigations for stress urinary incontinence
history and examination, positive stress test - demonstrable loss of urine on examination
urodynamics-urinary leakage during increase in abdo pressure in absence of detrusor muscle using catheter
management of stress urinary incontinence
non surgical physio with PFE
surgical mid urethral sling, colposuspension, periurethral bulking agents
what is overrative bladder/ urge urinary ncontinence
urinary urgency, usually with urinary frequency and nocturia with/without urgency urinary incontince
risk factors for overactive bladder
age prolapse increased bmi ibs bladder irritants (caffeine, nicotine)
what is the pathology of overactive bladder
not well understood
involuntary detrusor muscle contractions
cause can be idiopathic / neurogenic(loss of cns inhibitory pathways)/bladder outlet obstruction
signs and symptoms of an overactive bladder
urgency, frequency, nocturia and urgency incontinence, impact on qol-sleep disorders, anxiety and depression
assess for enlarged prostate in males and prolapse in woman
investigations of overactive bladder
exclude infection with urine dip/msu voiding diaries assessing post void residual urodynamics cytoscopy for haemorhages/trabeculae
what is the management of overactive bladder
behavioural/lifestyle changes bladder retaining antimuscarinic drugs beta3 agonists botox neuromodulation (ptns/sns) surgical: augmentation cystoplasty and urinary diversion = last resort
what is overflow incontinece
involuntary leakage of urine when bladder is full. usually due to chronic retention secondary to obstruction/ an atonic bladder
what can cause overflow incontinence
outlet obstruction underactive detrusor muscle bladder neck stricture urethral stricture dhx alpha adrenergics, anticholnergics,sedative bladder denervation following surgery
what is continuous incontinence
continuous loss of urine all the time. could be due to vesicovaginal fistula,ectopic urethra/vagina
what is functional incontinence
due to severe cognitive impairment/mobility limitations, preventing use of toilet. bladder function is normal
what is mixed incontinence
more than 1 type of urinary incontinence
usually seen in older patients
what is benign prostatic hyperplasia
non malignant growth/hyperplasia of prostate tissue, common cause of lower urinary tract symptoms in men.
what are the risk factors for bph
hormonal effects of testosterone on prostate tissue
pathology of bph
hyperplasia of both lateral lobes and median lobes, leading to compression of the urethra and therefore bladder outflow obstruction. can see hyperplasia of stroma and glands
what are the signs and symptoms of bph
hesitancy in starting urination poor stream dribbling post micturition frequency, nocturia can present with acute retention
what causes should be excluded for patients with symptoms of bph
bladder/prostate cancer cauda equina high pressure chronic retention utis/ stis prostatitis neurogenic bladder urinary tract stones urethral stricture
what are the investigations for bph
urine dip/msu, post void residual, voiding diary
bloods - psa prostate specific antigen shown to predict prostate vol - use with caution if concerned abt cancer
imaging - ultrasound to assess upper renal tracts
flow studies/urodynamics
cytoscopy if concerned about cancer
how to manage bph
lifestyle: weightloss, reduce caffeine and fluid intake in evening, avoid constipation
medical: alpha blocker, alpha1ar present on prostate stromal smooth muscle and bladder neck. blockage results in relaxation, thus improving urinary flow rate.
5 alpha reductase inhibitor prevents conversation of test to dht (which promotes growth and enlargement of prostate) so results in shrinkage
surgery - transurethral resection of prostate - debulks prostate to produce adequate channel for urine flow
what are the complications for bph
progressive bladder distention, causing chronic painless retention and overflow incontinence.
if undetected can lead to bilateral upper tract obstruction and renal impairment with patient presenting with chronic renal repair
