urinary incontinence and bph

Question 1

what is the urinary bladder

Answer 1

muscular reservoir of urine

Question 2

what is blood supply to bladder

Answer 2

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

Question 3

lymphatics of bladder

Answer 3

internal iliac nodes and paraaortic nodes

Question 4

what is urethra

Answer 4

channel from neck of bladder to external urethral orifice

Question 5

blood supply of urethra

Answer 5

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

Question 6

lymphatics of urethra

Answer 6

proximal urethra into internal iliac nodes

distal urethra to superficial inguinal lymph nodes

Question 7

nerve supply of urethra

Answer 7

vesical plexus and pudendal nerve

Question 8

blood supply of prostate

Answer 8

inferior vesicle artery

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

Question 9

lymphatics of prostate

Answer 9

internal and sacral nodes

Question 10

nerve supply of prostate

Answer 10

autonomic nervous system

Question 11

what is normal micturition

Answer 11

intermittent voiding of urine stored in bladder

Question 12

what happens in filling phase of micturition

Answer 12

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

Question 13

what happens in voiding phase of micturition

Answer 13

bladder contracts and expels urine,

urethral spincter relaxes and urethra opens

Question 14

in adults how can voiding be initiated/ inhabitiated

Answer 14

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

Question 15

innervation of micturition for bladder emptying

Answer 15

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

Question 16

describe innervation of micturition when bladder filling again

Answer 16

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

Question 17

what is stress urinary incontinence

Answer 17

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

Question 18

what are the risk factors for stress urinary incontinence

Answer 18

ageing 
obesity
smoking
pregnancy
route of delivery

Question 19

what is the pathology of stress urinary incontinence

Answer 19

impaired bladder and urethral support and impaired urethral closure

Question 20

what are the signs and symptoms of stress urinary incontinence

Answer 20

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

Question 21

what are the investigations for stress urinary incontinence

Answer 21

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

Question 22

management of stress urinary incontinence

Answer 22

non surgical physio with PFE

surgical mid urethral sling, colposuspension, periurethral bulking agents

Question 23

what is overrative bladder/ urge urinary ncontinence

Answer 23

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

Question 24

risk factors for overactive bladder

Answer 24

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

Question 25

what is the pathology of overactive bladder

Answer 25

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

Question 26

signs and symptoms of an overactive bladder

Answer 26

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

Question 27

investigations of overactive bladder

Answer 27

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

Question 28

what is the management of overactive bladder

Answer 28

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

Question 29

what is overflow incontinece

Answer 29

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

Question 30

what can cause overflow incontinence

Answer 30

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

Question 31

what is continuous incontinence

Answer 31

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

Question 32

what is functional incontinence

Answer 32

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

Question 33

what is mixed incontinence

Answer 33

more than 1 type of urinary incontinence | usually seen in older patients

Question 34

what is benign prostatic hyperplasia

Answer 34

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

Question 35

what are the risk factors for bph

Answer 35

hormonal effects of testosterone on prostate tissue

Question 36

pathology of bph

Answer 36

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

Question 37

what are the signs and symptoms of bph

Answer 37

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

Question 38

what causes should be excluded for patients with symptoms of bph

Answer 38

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

Question 39

what are the investigations for bph

Answer 39

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

Question 40

how to manage bph

Answer 40

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

Question 41

what are the complications for bph

Answer 41

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