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BRS Y2 > Urinary Incontinence and BPH > Flashcards

Urinary Incontinence and BPH Flashcards

1
Q

At what point during gestation does the prostate develop?

A

Weeks 10-16

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2
Q

What hormone influences prostate development?

A

Dihydrotestosterone

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3
Q

From what artery does the arterial supply to the prostate arise from?

A

Inferior vesical artery

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4
Q

What is the name of the artery that supplies the prostate?

A

Prostatic artery

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5
Q

What does the prostatic artery divide into?

A

Urethral and capsular

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6
Q

What arteries does the urethral artery give rise to?

A

Flock’s and Badenoch’s arteries

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7
Q

Where are Flock’s arteries?

A

1 and 11 o clock

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8
Q

Where are Badenoch’s arteries?

A

5 and 7 o clock

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9
Q

What undertakes the venous drainage of the prostate?

A

Peri-prostatic venous plexus

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10
Q

What does the peri-prostatic venous plexus drain into?

A

Internal iliac vein

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11
Q

Describe the lymph drainage of the prostate

A

Firstly drains to the obturator nodes and then the internal iliac chain

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12
Q

What is the set of zones of the prostate known as? name them individually top

A 
McNeal's zones:
Transition zone
Central zone
Peripheral zone
Anterior fibromuscular stroma
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13
Q

What is the function of the prostate?

A

To liquefy ejaculate

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14
Q

What does BPH stand for? What term for it would be pathologically incorrect?

A

Benign prostatic hyperplasia

You can’t call it hypertrophy

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15
Q

What condition may BPH develop into?

A

BPO= benign prostatic obstruction

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16
Q

How does BPH manifest?

A

Reduced urinary flow
Urinary frequency
Urgency
Nocturia

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17
Q

Describe the pathophysiology of BPH

A

Hihger number of epithelial and stromal cells in peri urethreal area of the prostate due to testosterone and grwoth factors
Higher urethral resistance
Compensatory changes in bladder function
Higher detrusor pressure needed to maintain urinary flow

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18
Q

What role does the capsule play in BPH?

A

It transmits the ‘pressure’ of tissue expansion to the urethra and leads to an increase in urethral resistance

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19
Q

How does the size of the prostate affect BPH?

A

As the size of the prostate increases so does the degree of obstruction

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20
Q

What type of tissue makes up most of the gland?

A

Smooth muscle

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21
Q

What forces increase urethral resistance?

A

Both active and passive

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22
Q

What is the most abundant adrenoceptor in the prostate?

A

⍺1A

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23
Q

What are lower urinary tract symptoms in men related to and how is this significant?

A

They are related to obstruction induced changes in bladder function rather than directly outflow obstruction
This means even after surgical relief for BPH symptoms persist in 1/3 of men

24
Q

What are obstruction induced changes?

A

Detrusor instability

Reduced detrusor contractility

25
Q

What symptoms associated with voiding may arise in BPH?

A

Reduced flow, hesitancy, incomplete emptying, strangury

26
Q

What symptoms associated with storage may arise in BPH?

A

Higher frequency (daytime and nocturia), urgency, incontinence

27
Q

What is t very important to ask about in BPH and why?

A

Fluid intake as it greatly affects lower urinary tract symptoms

28
Q

What is examined in suspected BPH and what would results be?

A 
General examination
Palpable bladder
Ballotable kidneys
Phimosis- inability to retract foreskin
Meatal stenosis- abnormal narrowing of the urethral opening
29
Q

What investigations can be done in BPH?

A 
Urine dipstick
Flow rate + PVR
IPSS Questionnaire 
Bladder diary
PSA, creatinine
Flexible cystoscopy in some circumstances
TRUS prostate
Urodynamic studies
30
Q

What conservative management can be used for BPH?

A 
Watchful waiting 
Lifestyle changes (look at bladder diary and suggest changes such as when to stop fluid intake in the evening, cut/reduce caffeine intake
31
Q

What pharmacological treatment is used to treat BPH?

A

Alpha adrenergic antagonists

5 alpha reductase inhibitors

32
Q

What surgical treatment is used to treat BPH?

A

Gold standard= trans urethral resection of the prostate (TURP)
Embolisation
Rezum- use of steam

33
Q

What is urinary incontinence (UI)?

A

The complaint of any involuntary loss of urine

34
Q

What is stress UI?

A

The complaint of involuntary leakage on exertion /sneezing/coughing

35
Q

What is urge UI?

A

The complaint of an involuntary leakage accompanied by or immediately preceded by urgency

36
Q

What is mixed UI?

A

The complaint of an involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing

37
Q

What is continuous incontinence?

A

Continuous leakage

38
Q

What is overflow incontinence?

A

Leakage associated with urinary retention

39
Q

What is nocturnal enuresis?

A

The complaint of loss of urine occurring during sleep

40
Q

What is post micturition dribble?

A

The complain of an involuntary loss of urine immediately after passing urine

41
Q

What groups are more likely to suffer from UI?

A 
Older people
Pregnant and those who have had a vaginal delivery
Obesity
Constipation
Drugs eg being on ACE inhibitors
Smoking
Family history
42
Q

What investigations are done for UI?

A 
Urine dipstick
Flow rate and post-void residual
Bladder diary
Pad tests- the pads are weighed 
Patient symptom scores/validated QoL questionnaire
Urodynamic/video-urodynamic studies
43
Q

What groups is stress incontinence more common in?

A

Women of young to middle age

44
Q

What groups is stress incontinence uncommon in?

A

Men who have not had prostate surgery

45
Q

What are the 5 causative theories of stress incontinence in women?

A 
Urethral causative theory
Intrinsic sphincter deficiency
Integral theory
Hammock theory
Trampoline theory
46
Q

What are non surgical treatments for stress incontinence?

A

Lifestyle changes eg weight loss, cessation of smoking, modification of high/low fluid intake
Supervised pelvic floor exercises
Bladder re-training

47
Q

What are pharmacological treatments for stress incontinence and when are they used?

A

Oestrogen therapy if there is evidence of atrophy

Oral medical therapy in rare cases

48
Q

What are surgical treatments for stress incontinence?

A

Occlusive e.g. bulking, compressive (AUS), a material is inserted to cause a physical obstruction around the urethra or artificial sphincter holds in urine then they have to press a button to void
Supportive (mid-urethral sling, colposuspension)
Ileal conduit diversion

49
Q

What are the 3 causative theories of stress incontinence in men?

A

Sphincter incompetence
Reduction in urethral sphincter length
Post-operative strictures

50
Q

What 5 structures control continence?

A 
Detrusor muscle
Internal sphincter
Ureterotrigonal muscles
Levator muscles
Rhabdosphincter (external sphincter muscle)
51
Q

What are symptoms of overactive bladder (OAB)?

A

Urinary frequency
Urgency
Nocturia with or without leak

52
Q

What are the names for oab with and without incontinence?

A 
With= oab wet
Without= oab dry
53
Q

Which gender has a higher prevalence for oab wet vs dry?

A

Women have a higher prevalence for oab wet

Men have a higher prevalence for oab dry

54
Q

What are differential diagnoses for oab?

A 
UTI
DO
Urethral syndrome
Urethral diverticulum
Interstitial cystitis
Bladder cancer
Large residual volume
55
Q

What lifestyle changes can be suggested for oab?

A

Decreasing caffeine intake
Stopping smoking
Losing weight if obese

56
Q

What pharmacological treatment is used for oab?

A

Anti cholinergics

Beta 3 agonists

57
Q

What surgical treatment can be used for oab?

A

Posterior tibial nerve stimulation (PTNS)
Intravesical injection of botulinum toxin A
Neuromodulation
Clam (augmentation) cystoplasty
Urinary diversion if severe

BRS Y2 (85 decks)

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