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BRS2 Term 2 > Urinary incontinence and BPH > Flashcards

Urinary incontinence and BPH Flashcards

1
Q

What are McNeal’s prostate zones?

A
  • zones of prostate
  • transition zone: 10% of glandular tissue of prostate, site of origin of BPH
  • central zone: 25% of glandular tissue of prostate
  • peripheral zone: 65% of glandular tissue of prostate
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2
Q

What is the function of the prostate?

A

liquefy ejaculate

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3
Q

What is benign prostatic obstruction?

A

bladder outflow obstruction caused by benign prostatic enlargement

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4
Q

What is the pathophysiology of BPH?

A
  • inc. number of epithelial and stromal cells in the peri-urethral area of prostate
  • in response to testosterone and growth factors
  • leads to inc. urethral resistance–> compensatory changes in bladder–> inc. detrusor pressure–> reduced urinary flow, frequency and urgency, and nocturia
  • N.B. size of prostate does not equal degree of obstruction
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5
Q

What is the most abundant adrenoceptor subtype in the human prostate?

A

alpha 1A- regulates active smooth muscle tone

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6
Q

What obstruction-induced bladder changes occur in BPH?

A
  • detrusor instability (bladder becomes overactive) and reduced compliance–> frequency and urgency
  • reduced detrusor contractility–> hesitancy, intermittency, inc. residual urine and sometimes detrusor failure (retention)
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7
Q

What are voiding symptoms in BPH?

A
  • reduced flow
  • hesitancy
  • incomplete emptying
  • strangury (strain passing urine)
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8
Q

What are storage symptoms in BPH?

A
  • inc. daytime frequency and nocturia
  • urgency
  • incontinence
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9
Q

What examinations would you do for a person with LUTS / BPH symptoms?

A
  • general exam
  • palpable bladder
  • ballotable kidneys
  • phimosis (narrowing of foreskin so can’t pull back)
  • meatal stenosis (scarring/narrowing of opening of urethra)
  • DRE looking for enlarged prostate, nodules, anal tone and sensation
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10
Q

What investigations would you do for a man with presumed BPH?

A
  • urine dipstick
  • flow rate + PVR
  • IPSS questionnaire (to assess symptoms related to BPE)
  • bladder diary
  • USS KUB if impaired renal function, loin pain, haematuria, renal mass on examination
  • PSA, creatinine
  • flexible cystoscopy
  • TRUS to look at prostate
  • urodynamic studies (pressure flow)
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11
Q

How do we manage BPH?

A
  • watchful waiting
  • lifestyle changes–> what they drink, how much they drink
  • pharmacological treatment:
  • -> alpha-adrenergic antagonists e.g. Tamsulosin, alfuzosin, doxazosin- relax bladder neck
  • -> 5-alpha reductase inhibitors e.g. Finasteride, dustasteride- shrink prostate, preventing disease progression and need for surgery
  • -> combination therapy
  • surgery:
  • -> TURP
  • -> Rezume
  • -> uroLIFT
  • -> Millin’s prostatectomy
  • -> embolisation
  • -> HoLEP
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12
Q

What is urinary incontinence?

A

complaint of any involuntary loss of urine

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13
Q

What is stress urinary incontinence?

A
  • complaint of involuntary leakage on physical exertion/sneezing/coughing
  • more common in women of young-middle age
  • uncommon in men who haven’t had prostate surgery
  • usually due to weakening/damage to the muscles that prevent urination, such as the pelvic floor muscles and the urethral sphincter
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14
Q

What is urge urinary incontinence?

A
  • complaint of involuntary leakage accompanied by or immediately following urgency
  • usually caused bu overactivity of the detrusor muscles, which control the bladder
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15
Q

What is mixed urinary incontinence?

A

complaint of involuntary leakage of urine associated w/ urgency and also exertion, effort, sneezing, or coughing

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16
Q

What is continuous incontinence?

A

continuous leakage- worrying sign

17
Q

What is overflow incontinence?

A

leakage associated w/ urinary retention

18
Q

What is nocturnal enuresis?

A

complaint of loss of urine during sleep

19
Q

What is postmicturition dribble?

A

complaint of involuntary loss of urine immediately after passing urine

20
Q

What are the risk factors for urine incontinence?

A
  • increasing age
  • pregnancy and vaginal delivery
  • obesity
  • constipation
  • drugs e.g. ACEIs
  • smoking
  • family history
  • gynaecological surgery e.g. hysterectomy
  • menopause
21
Q

What investigations would you do for urinary incontinence?

A
  • urine dipstick
  • flow rate and post void residual (high= overflow incontinence)
  • bladder diary
  • 24h pad tests
  • patient symptom scores/validated quality of life questionnaire
  • urodynamic/video-urodynamic studies
22
Q

What are the non-surgical treatments for stress urinary incontinence?

A
  • lifestyle changes e.g. weight loss, stop smoking, modifying fluid intake
  • supervised pelvic floor exercises
  • bladder re-training
23
Q

What are the pharmacological treatments for stress urinary incontinence in women?

A
  • topical oestrogen therapy if evidence of atrophy

- oral medical therapy in rare cases

24
Q

What are the surgery options for stress urinary incontinence?

A
  • occlusive e.g. bulking (injection to cause physical obstruction to urethra), compressive (artificial urinary sphincter)
  • supportive (mid-urethral sling, colposuspension)
  • ileal conduit diversion in end stage cases
25
Q

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

A
  • sphincter incompetence
  • reduction in urethral sphincter length
  • post-operative strictures
26
Q

What are the pharmacological treatments for stress urinary incontinence in men?

A

oral medical therapy in rare cases (if not fit for surgery)

27
Q

What is overactive bladder syndrome?

A
  • OAB= urinary frequency, urgency, nocturia with or without leak
  • men have higher prevalence of OAB without leaking
  • women have higher prevalence of OAB w/ leaking
28
Q

What are other differentials for urge urinary incontinence?

A
  • UTI
  • urethral syndrome
  • urethral diverticulum
  • interstitial cystitis
  • bladder cancer
  • large residual volume
29
Q

What are the non-surgical treatments for urge urinary incontinence?

A
  • decreasing caffeine intake
  • stop smoking
  • losing weight if obese
  • bladder retraining
  • pelvic floor muscle exercises
30
Q

What are the pharmacological treatments available for urge urinary incontinence?

A
  • anticholinergics e.g. solifenacin, tolterodine, trospium
  • beta-3-agonists e.g. betmiga
  • side effects: dry mouth, constipation, blurry vision, inc. bp
31
Q

What are the surgical treatment options for urge urinary incontinence?

A
  • posterior tibial nerve stimulation (PTNS)
  • intravesical injection of botulinum toxin A every 6-9 months
  • neuromodulation
  • clam cystoplasty
  • urinary diversion if very severe cases (stoma bag)

BRS2 Term 2 (14 decks)

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