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BRS 2 > Urinary Incontinence and BPH > Flashcards

Urinary Incontinence and BPH Flashcards

1
Q

When does the prostate develop during gestation?

A

10-16 weeks of gestation from epithelial buds

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2
Q

Which sinus does the prostate develop from during gestation?

A

Posterior aspect of the urogenital sinus, to invade the mesenchyme

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3
Q

What is the main influencing hormone of the prostate?

A

Dihydrotestosterone

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4
Q

Which receptors does dihydrotestosterone act upon?

A

Mesenchymal androgen receptors

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5
Q

Which artery does the prostatic artery branch from?

A

Inferior vesicular artery

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6
Q

The prostatic artery divides into which arteries?

A

Urethral and capsular groups of arteries

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7
Q

Which two arteries arise from the urethral group?

A

Flock’s and Badenoch’s arteries

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8
Q

Describe venous drainage of the prostate?

A
  • Peri-prostatic venous plexus

* The periprostatic venous plexus  Drains into the internal iliac vein.

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9
Q

What is the lymphatic drainage of the prostate gland?

A

Obturator nodes and interna liliac chain

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10
Q

What zone classification is used to categorise the prostate gland?

A

McNeal’s Zones

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11
Q

What are the zones of the prostate gland?

A

Transition Zone
Central Zone
Peripheral Zone
Anterior fibromuscular stroma

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12
Q

What % of the prostate gland is represented by the transition zone?

A

10%

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13
Q

Which prostate zone is implicated in the site of origin for benign prostatic hyperplasia?

A

Transition zone

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14
Q

Which zone represents the majority of the prostate gland?

A

Peripheral zone

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15
Q

What is the overall function of the prostate gland?

A

Liquify the ejaculate

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16
Q

What are lower urinary tract symptoms (prostatism)?

A

Non-specific term for symptoms which may be attributed to lower urinary tract dysfunction

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17
Q

What is benign prostatic enlargement?

A

Clinical finding of enlarged prostate

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18
Q

What is benign prostatic hyperplasia?

A

Histological diagnosis

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19
Q

What is bladder outflow obstruction?

A

Urodynamically proven obstruction to passage of urine

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20
Q

What is BPH?

A

• Increased number of epithelial and stromal cells in the peri-urethral area of the prostate in response to androgen (testosterone) and growth factors.

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21
Q

What is the consequent effect of BPH to urethral resistance?

A

Increased urethral resistance

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22
Q

What happens to detrusor pressure in BPH?

A

Detrusor pressure increased, in order to maintain urinary flow

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23
Q

What are the symptoms of BPH?

A

Decreased urinary flow, urinary frequency, urgency and nocturia

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24
Q

What is the correlation between prostate size and degree of obstruction?

A

There is no correlation

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25
How is active smooth muscle tone regulated?
Adrenergic nervous system | Alpha-1 adrenoceptor subtype
26
What is first phase BPH?
Characterised by increased number of nodules - growth is slow (glandular nodules are larger than stromal nodules)
27
Which type of nodules are dominant in the second phase of BPH?
Glandular nodule
28
What is the second phase of BPH?
Significant increase in larger nodules (size of each nodule increasing)
29
What are the two obstruction induced changes in urinary inconinence?
Detrusor instability/decreased compliance - frequency and urgency Decreased detrusor contractility - further deterioration in the force of the urinary stream, hesitancy, intermittency, increased residual urine and detrusor failure
30
What is voiding?
Reduced flow, hesitancy, incompletely emptying and strangury
31
What is storage in terms of BPH?
Frequency (daytime and nocturia), urgency, incontinence
32
What is examined in patients with urinary incontinence?
``` Palpable bladder Ballotable kidneys Phimosis Meatal stenosis Enlarged prostate on DRE, size, consistency, nodules, anal tone and sensation ```
33
What investigations are conducted in a patient with BPH?
* Urine dipstick * Flow rate + Post void residual (PVR) – Measures the velocity of passing urine, in addition to the volume. * IPSS Questionnaire – Designed to assess symptoms of prostate enlargement. * Bladder diary – Objective way to identify how much the patient is drinking, volume and times. * Ultrasound KUB – Impaired renal function, loin pain, haematuria, renal mass on examination. * PSA, creatinine * Flexible cystoscopy * TRUS prostate * Urodynamic studies
34
What is PVR?
Post-void residual - measures the velocity of passing urine, in addition to the volume
35
What is the initial management and treatment for patients with BPH?
Watchful waiting Lifestyle changes (Caffeine exclusion) Pharmacological treatment
36
What drugs are recommended in patients with diagnosed BPH?
Alpha-adrenergic antagonists - minimise smooth muscle contraction (relaxation allows urine to pass easily). 5-alpha reductase inhibitors
37
What are three examples of alpha-adrenergic antagonists?
Tamsulosin Alfuzosin Doxazosin
38
How do alpha-adrenergic antagonists work in BPH?
Minimise smooth muscle contraction (relaxation allows urine to pass easily)
39
What is TUPR?
Cystoscope inserted through the urethra and bladder to ablate the prostate tissue
40
What is rezum?
Eject steam into the prostate
41
What is UroLIFT?
Pinning of the prostate lobes
42
What is a Millin's prostateectomy?
Open invasive operation to remove the prostate through the bladder
43
What is embolisation?
Coils into the vessels, which provide the main blood supply - prostate shrinkage
44
What is HoLEP?
Laser to core out the entire prostate
45
What is stress incontinence?
The complaint of involuntary leakage on exertion/sneezing/coughing
46
What is urge incontinence?
The complaint of an involuntary leakage accompanied by or immediately preceded by urgency
47
What is mixed urinary incontinence?
Complaint of an involuntary leakage of urine associated with urgency and exertion, effort, sneezing or coughing
48
What is continuous incontinence?
Continuous leakage
49
What is nocturnal enuresis?
Complaint of loss of urine occurring during sleep
50
What is post-micturition dribble?
Complain of an involuntary loss of urine immediately after passing urine.
51
What factors affect incontinence?
``` Factors: • Increasing age • Pregnancy & Vaginal delivery • Obesity • Constipation • Drug: ACE inhibitors • Smoking • Family History • Prolapse/hysterectomy/menopause ```
52
What is a pad test?
Weight 24 hours of pads and compare with the weight of a dry pad to objectively identify the volume of urine that is leaking.
53
What investigations are conducted in patients with incontinence?
* Urine dipstick * Flow rate and post-void residual * Bladder diary * Pad tests – Weight 24 hours of pads and compare with the weight of a dry pad to objectively identify the volume of urine that is leaking. * Patient symptom scores/validated QoL questionnaire * Urodynamic/video urodynamic studies
54
Stress incontinence is common in which sex?
Women of young to middle age
55
What are the non-surgical treatments for incontinence?
``` Lifestyle changes • Weight loss • Cessation of smoking • Modification of high/low fluid intake Supervised pelvic floor exercises with pelvic floor physiotherapists. Bladder re-training. ```
56
What are the pharmacological treatments for incontinence?
Oestrogen therapy – if evidence of atrophy. Oestrogen receptors reside within the urethra, pelvic, floor, vagina and the base of the bladder. Oral medical therapy in rare cases.
57
What surgical treatments are available for incontinence?
* Occlusive (bulking, compressive (AUS) * Supportive (mid-urethral sling, colposuspension) – Prevents movement of the urethra, and supports the urethral sphincter. * Ileal conduit diversion- In end stage cases
58
What 5 structures control continence?
1) Detrusor muscle 2) Internal sphincter 3) Ureterotrigonal muscles 4) Levator muscles 5) Rhabdosphincter (external sphincter muscle).
59
What surgery is available for male incontinence?
Occlusive (bulking, compressive (AUS). Supportive (suburethral sling) Ileal conduit diversion
60
What is UUI?
``` Urge Urinary Incontinence (UUI) • OAB symptom syndrome: Urinary frequency, urgency, nocturia, with or without leak. • 16% in men and women. • Prevalence men > women for OAB-dry. • Women > men for OAB-wet ```
61
What is OAB syndrome?
Urinary frequency, urgency, nocturia with or without leak
62
What are the differential diagnoses for incontinence?
``` Differential diagnosis • UTI • DO • Urethral syndrome • Urethral diverticulum • Interstitial cystitis • Bladder cancer • Large residual volume ```
63
What lifestyle changes are recommended in patients with incontinence?
Lifestyle changes: Decreasing, caffeine intake, stopping smoking, losing weight if obese. • Bladder re-training • Pelvic floor muscle exercises
64
What pharmacotherapy is available for incontinence?
• Efficacy is 50-75% • Anti-cholinergic (solifenacin, tolterodine, trospium) N.B: Dry mouth, blurry vision and constipation. • Beta-3 agonist (betmiga) – better risk profile.
65
What surgical interventions are available for incontinence?
Surgery • Posterior tibial nerve stimulation (PTNS) • Intravesical injection of botulinum toxin A • efficacy is 36-89%, mean efficacy is 70%, upto a mean time of 6 months • Neuromodulation • 50% cure rate, 25% significant improvement of symptoms, 25% failure rate • Clam (augmentation) cystoplasty • 50% cure rate, 25% significant improvement of symptoms, 25% failure rate • Urinary diversion is an option if all else fails in very severe cases

BRS 2 (62 decks)

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