Urinary incontinence and BPH

Question 1

What lymphatics do the ureters drain into?

Answer 1

-Left ureter drains into left para-aortic nodes.

-Right ureter drains into right paracaval and interaortocaval lymph nodes

Question 2

What is the nerve supply to the Female GU system?

Answer 2

Autonomic nervous system

Question 3

When is the bladder a pelvic and abdomino-pelvic organ respectively?

Answer 3

Pelvic - when empty

Abdomino-pelvic - when it rises up the abdominal cavity due to distention.

Question 4

What are the 3 layers of the bladder?

Answer 4

Outer loose connective tissue

Middle smooth muscle and elastic fibres

Inner layer lined with transitional epithelium

Question 5

Where does the bladder get its blood supply from?

Answer 5

Superior and inferior vesical branches of internal iliac artery.

Drained by vesical plexus which drains into the internal iliac vein

Question 6

What is the lymphatic drainage of the bladder?

Answer 6

Internal iliac nodes and then paraaortic nodes

Question 7

What is the blood supply to the prostate?

Answer 7

Inferior vesical artery

Question 8

What is the lymphatic drainage of the prostate?

Answer 8

Internal and sacral nodes

Question 9

What is the nerve supply to the prostate?

Answer 9

ANS

Question 10

What is the lymphatic drainage of the 3 parts of the male urethra respectively?

Answer 10

Prostatic + Membranous drain into obturator and internal iliac nodes

Spongy urethra drains into the deep and superficial inguinal nodes

Question 11

What is the nerve supply to the male urethra?

Answer 11

Prostatic plexus

Question 12

What is normal micturition characterised by?

Answer 12

The intermittent voiding of urine stored in the bladder

Question 13

What type of reflex is micturition in infants?

Answer 13

Local spinal reflex in which the bladder empties after reaching a critical pressure

Question 14

What receptors are stimulated as the bladder fills?

Answer 14

M3 receptors.

Question 15

What muscle contracts in urination?

Answer 15

Detrusor muscle

Question 16

Which nerve fibers are activated to inhibit the internal urethral sphincter and allow bladder emptying?

Answer 16

parasympathetic system

Question 17

Which receptors are activated by the sympathetic nervous system to relax the detrusor muscles and allow filling?

Answer 17

Beta 3 receptors

Question 18

Where do the sympathetic fibers that stimulate the M3 fibers originate from?

Answer 18

T11-L2

Question 19

Define Urinary Stress incontinence.

Answer 19

Complaint of involuntary leakage on effort or exertion or sneezing or coughing

Question 20

What is the abdominal operation where you put two stitches either side of bladder neck to elevate it, reduces the movement of bladder neck when they cough/sneeze —> less leakage?

Answer 20

Colposuspension

Question 21

What are the surgical options for those experiencing Sress urinary incontinence?

Answer 21

-Periurethral bulking agents - Injections to bulk up urethral sphincter which obstructs it meaning that it doesn’t leak

-Colposuspension

-Surgical mid urethral sling

Question 22

What is the pathology of Urge urinary incontinence?

Answer 22

Involuntary detrusor (bladder wall) muscle contractions.

Question 23

What do you assess for in men and women suffering from urge urinary incontinence?

Answer 23

Assess for enlarged prostate in males and prolapse in women

Question 24

What is prolapse?

Answer 24

Prolapse in women refers to the downward descent or displacement of one or more pelvic organs, such as the uterus, bladder, or rectum, from their normal position within the pelvis.

Question 25

What is it called when you look inside the bladder with a camera?

Answer 25

Cytoscopy

Question 26

What kind of drugs can we give to treat an overactive bladder?

Answer 26

-Antimuscarinic drugs, blocks the M3 receptors on the detrusor muscles

-Beta 3 agonists, relax the detrusor muscles

Question 27

What peripheral nerve do we stimulate thatt connects to the sacral nerves tha innervate the bladder when doing neuromodulation for an overactive bladder?

Answer 27

Tibial nerve

Question 28

What do we directly stimulate to help improve overactive bladder symptoms.

Answer 28

S3

Question 29

What other treatment can we give to help treat overactive bladders?

Answer 29

Botox- blocks the neuromuscular junction

Question 30

What surgical intervention is done to increase bladder capacity?

Answer 30

Augmentation cytoplasty

Question 31

What is the other surgical intervention for an overactive bladder?

Answer 31

Urinary diversion

Question 32

What kind of drugs can cause overflow incontinence?

Answer 32

• Alpha adrenergics
• Anticholinergics
• Sedatives

Question 33

What specific blood test can we do to predict prostate volume?

Answer 33

PSA test (prostate specific antigen test)

Question 34

What medical management is available to treat benign prostatic hyperplasia?

Answer 34

Alpha blockers
5-alpha reductase inhibitors

Question 35

How do alpha blockers work to treat benign prostatic hyperplasia causing a compressed urethra?

Answer 35

there are alpha-1 receptors on prostate stromal smooth muscle and bladder neck and blockage results in relaxation → improving urinary flow rate

Question 36

How do 5-alpha reductase inhibitors work to improve peeing problems?

Answer 36

Prevents conversion of T to DHT (which promotes growth and enlargement of prostate) so results in shrinkage → improving urinary flow rate and obstructive symptoms

Question 37

What surgical intervention is there for BPH?

Answer 37

Transurethral resection of the prostate (TURP)-