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urinary incontinence and bph Flashcards

1
Q

what is the urinary bladder

A

muscular reservoir of urine

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2
Q

what is blood supply to bladder

A

superior and inferior vesical branches of internal iliac artery. drained by vesical which drains into internal iliac vein

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3
Q

lymphatics of bladder

A

internal iliac nodes and paraaortic nodes

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4
Q

what is urethra

A

channel from neck of bladder to external urethral orifice

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5
Q

blood supply of urethra

A

internal pudendal arteries and inferior vesicle branches of vaginal arteries with corresponding venous drainage

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6
Q

lymphatics of urethra

A

proximal urethra into internal iliac nodes

distal urethra to superficial inguinal lymph nodes

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7
Q

nerve supply of urethra

A

vesical plexus and pudendal nerve

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8
Q

blood supply of prostate

A

inferior vesicle artery

venous drainage via prostatic plexus to vesical plexus and internal iliac vein

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9
Q

lymphatics of prostate

A

internal and sacral nodes

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10
Q

nerve supply of prostate

A

autonomic nervous system

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11
Q

what is normal micturition

A

intermittent voiding of urine stored in bladder

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12
Q

what happens in filling phase of micturition

A

bladder fills and distends without rise in intravesical pressure. urethral sphincter contracts and closes urethra

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13
Q

what happens in voiding phase of micturition

A

bladder contracts and expels urine,

urethral spincter relaxes and urethra opens

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14
Q

in adults how can voiding be initiated/ inhabitiated

A

control of external urethral sphincter keeping it closed until it is appropriate to urinate

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15
Q

innervation of micturition for bladder emptying

A 
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
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16
Q

describe innervation of micturition when bladder filling again

A

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

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17
Q

what is stress urinary incontinence

A

complaint of involuntary leakage on effect/exertion or on sneezing/coughing

18
Q

what are the risk factors for stress urinary incontinence

A 
ageing 
obesity
smoking
pregnancy
route of delivery
19
Q

what is the pathology of stress urinary incontinence

A

impaired bladder and urethral support and impaired urethral closure

20
Q

what are the signs and symptoms of stress urinary incontinence

A

involuntary leakage from urethra with exertion/effort on sneezing/coughing

21
Q

what are the investigations for stress urinary incontinence

A

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

22
Q

management of stress urinary incontinence

A

non surgical physio with PFE

surgical mid urethral sling, colposuspension, periurethral bulking agents

23
Q

what is overrative bladder/ urge urinary ncontinence

A

urinary urgency, usually with urinary frequency and nocturia with/without urgency urinary incontince

24
Q

risk factors for overactive bladder

A 
age
prolapse
increased bmi
ibs
bladder irritants (caffeine, nicotine)
25
Q

what is the pathology of overactive bladder

A

not well understood
involuntary detrusor muscle contractions
cause can be idiopathic / neurogenic(loss of cns inhibitory pathways)/bladder outlet obstruction

26
Q

signs and symptoms of an overactive bladder

A

urgency, frequency, nocturia and urgency incontinence, impact on qol-sleep disorders, anxiety and depression
assess for enlarged prostate in males and prolapse in woman

27
Q

investigations of overactive bladder

A 
exclude infection with urine dip/msu
voiding diaries
assessing post void residual
urodynamics
cytoscopy for haemorhages/trabeculae
28
Q

what is the management of overactive bladder

A 
behavioural/lifestyle changes
bladder retaining
antimuscarinic drugs
beta3 agonists
botox
neuromodulation (ptns/sns)
surgical: augmentation cystoplasty and urinary diversion = last resort
29
Q

what is overflow incontinece

A

involuntary leakage of urine when bladder is full. usually due to chronic retention secondary to obstruction/ an atonic bladder

30
Q

what can cause overflow incontinence

A 
outlet obstruction
underactive detrusor muscle
bladder neck stricture
urethral stricture
dhx alpha adrenergics, anticholnergics,sedative
bladder denervation following surgery
31
Q

what is continuous incontinence

A

continuous loss of urine all the time. could be due to vesicovaginal fistula,ectopic urethra/vagina

32
Q

what is functional incontinence

A

due to severe cognitive impairment/mobility limitations, preventing use of toilet. bladder function is normal

33
Q

what is mixed incontinence

A

more than 1 type of urinary incontinence

usually seen in older patients

34
Q

what is benign prostatic hyperplasia

A

non malignant growth/hyperplasia of prostate tissue, common cause of lower urinary tract symptoms in men.

35
Q

what are the risk factors for bph

A

hormonal effects of testosterone on prostate tissue

36
Q

pathology of bph

A

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

37
Q

what are the signs and symptoms of bph

A 
hesitancy in starting urination
poor stream
dribbling post micturition
frequency, nocturia
can present with acute retention
38
Q

what causes should be excluded for patients with symptoms of bph

A 
bladder/prostate cancer
cauda equina
high pressure chronic retention
utis/ stis
prostatitis
neurogenic bladder
urinary tract stones
urethral stricture
39
Q

what are the investigations for bph

A

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

40
Q

how to manage bph

A

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

41
Q

what are the complications for bph

A

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

brs2 (65 decks)

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