Urinary Incontinence And Urinary Tract Symptoms Flashcards
What is the lymphatic drainage of the bladder?
What is the arterial supply to the bladder?
Internal iliac nodes and paraaortic nodes
Superior and inferior vesicle branches of the internal iliac artery
What are there variations in anatomy of kidneys?
Single kidney
Horse-shoe kidney
Ectopic kidney
Ureters can be duplicated completely or partially
Where are the sites where kidney stone hold up points are most common?
Ureter-pelvic junction (UPJ)
Iliac vessels (middle)
Uretero-vesical junction (UVJ)
What nerve control the external urethra sphincter in females and males?
What is the arterial supply of the urinary tract in females and male?
Pudendal nerve
Fem: internal pudendal arteries and vaginal inferior vesicle arteries
Male: internal pudendal arteries, urethra-bulbo arteries and prostate inferior vesicle artery
What are the two phases of micturition?
Is micturition conscious in infants?
Storage: bladder is relaxed and acting as a reservoir, outlet is contracted to prevent leaking
Voiding: bladder contracts to push out urine and outlet relaxes to allow exit
No, its a reflex when bladder reaches a critical pressure
What is the neural control of micturition?
When going into voiding mode: Prefrontal cortex (as this is where we do decision making) allows pontine micturition centre (PMC) to go into voiding mode
This activates parasympathetic nucleus in thoracic spinal cord L1-L2 causing bladder contraction (detrusor muscle) and inhibits onuf’s (also parasympathetic) nucleus in the sacral spinal cord causing sphincter relaxation
The sympathetic nervous system comes from the sacral spinal cord S2-S4
What is stress urinary incontinence?
What are its risk factors?
What are the investigations?
How is it managed?
Involuntary leaking on effort or exertion or sneezing or coughing
RF: aging, obesity, smoking, pregnancy
Investigation: urodynamic test, vaginal examination, history
Management: physio for pelvic floor exercises, surgical sling to support urethra
What is urgency incontinence?
What are its RF?
What are the investigations?
What are the managements?
Urgency to pass urine, often comes with nocturia
RF: bladder irritants eg caffeine or nicotine, age, obesity
Investigations: exclude infection, bladder diary, urodynamics
Management: bladder retraining, antimuscarinic drugs, Botox injection to stop bladder
What is the pathology of benign prostate hyperplasia?
How does it present?
What are the investigations?
What are the treatments?
What must be excluded before diagnosing benign prostate hyperplasia?
Hyperplasia of prostate leading to compression of urethra and therefore bladder outflow obstruction, can be felt with rectal exam
Présentation: hard to start urination, poor stream, acute retention
Investigations: urine dipstick, PSA, Cystoscopy, urodynamics, US
Treatment: transurethral resection of prostate, alpha-blocker to relax muscle, weight loss, stop smoking, reduce caffeine
Exclude: Bladder cancer, prostate cancer, UTI
