Urinary incontinence and BPH Flashcards
What lymphatics do the ureters drain into?
-Left ureter drains into left para-aortic nodes.
-Right ureter drains into right paracaval and interaortocaval lymph nodes
What is the nerve supply to the Female GU system?
Autonomic nervous system
When is the bladder a pelvic and abdomino-pelvic organ respectively?
Pelvic - when empty
Abdomino-pelvic - when it rises up the abdominal cavity due to distention.
What are the 3 layers of the bladder?
Outer loose connective tissue
Middle smooth muscle and elastic fibres
Inner layer lined with transitional epithelium
Where does the bladder get its blood supply from?
Superior and inferior vesical branches of internal iliac artery.
Drained by vesical plexus which drains into the internal iliac vein
What is the lymphatic drainage of the bladder?
Internal iliac nodes and then paraaortic nodes
What is the blood supply to the prostate?
Inferior vesical artery
What is the lymphatic drainage of the prostate?
Internal and sacral nodes
What is the nerve supply to the prostate?
ANS
What is the lymphatic drainage of the 3 parts of the male urethra respectively?
Prostatic + Membranous drain into obturator and internal iliac nodes
Spongy urethra drains into the deep and superficial inguinal nodes
What is the nerve supply to the male urethra?
Prostatic plexus
What is normal micturition characterised by?
The intermittent voiding of urine stored in the bladder
What type of reflex is micturition in infants?
Local spinal reflex in which the bladder empties after reaching a critical pressure
What receptors are stimulated as the bladder fills?
M3 receptors.
What muscle contracts in urination?
Detrusor muscle
Which nerve fibers are activated to inhibit the internal urethral sphincter and allow bladder emptying?
parasympathetic system
Which receptors are activated by the sympathetic nervous system to relax the detrusor muscles and allow filling?
Beta 3 receptors
Where do the sympathetic fibers that stimulate the M3 fibers originate from?
T11-L2
Define Urinary Stress incontinence.
Complaint of involuntary leakage on effort or exertion or sneezing or coughing
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?
Colposuspension
What are the surgical options for those experiencing Sress urinary incontinence?
-Periurethral bulking agents - Injections to bulk up urethral sphincter which obstructs it meaning that it doesn’t leak
-Colposuspension
-Surgical mid urethral sling
What is the pathology of Urge urinary incontinence?
Involuntary detrusor (bladder wall) muscle contractions.
What do you assess for in men and women suffering from urge urinary incontinence?
Assess for enlarged prostate in males and prolapse in women
What is prolapse?
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.
What is it called when you look inside the bladder with a camera?
Cytoscopy
What kind of drugs can we give to treat an overactive bladder?
-Antimuscarinic drugs, blocks the M3 receptors on the detrusor muscles
-Beta 3 agonists, relax the detrusor muscles
What peripheral nerve do we stimulate thatt connects to the sacral nerves tha innervate the bladder when doing neuromodulation for an overactive bladder?
Tibial nerve
What do we directly stimulate to help improve overactive bladder symptoms.
S3
What other treatment can we give to help treat overactive bladders?
Botox- blocks the neuromuscular junction
What surgical intervention is done to increase bladder capacity?
Augmentation cytoplasty
What is the other surgical intervention for an overactive bladder?
Urinary diversion
What kind of drugs can cause overflow incontinence?
- Alpha adrenergics
- Anticholinergics
- Sedatives
What specific blood test can we do to predict prostate volume?
PSA test (prostate specific antigen test)
What medical management is available to treat benign prostatic hyperplasia?
Alpha blockers
5-alpha reductase inhibitors
How do alpha blockers work to treat benign prostatic hyperplasia causing a compressed urethra?
there are alpha-1 receptors on prostate stromal smooth muscle and bladder neck and blockage results in relaxation → improving urinary flow rate
How do 5-alpha reductase inhibitors work to improve peeing problems?
Prevents conversion of T to DHT (which promotes growth and enlargement of prostate) so results in shrinkage → improving urinary flow rate and obstructive symptoms
What surgical intervention is there for BPH?
Transurethral resection of the prostate (TURP)-
