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Uro > Urinary incontinence and UT symptoms > Flashcards

Urinary incontinence and UT symptoms Flashcards

1
Q

What structures are common in both male and female genitourinary systems?

A

2 Kidneys, 2 ureters, Urinary bladder, Urethra

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2
Q

What additional structure is found in the male genitourinary system?

A

Prostate

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3
Q

What is the function of the ureters?

A

Transport urine from the kidneys to the bladder

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4
Q

Function of the kidneys

A

Remove waste products of metabolism, excess water and salts from the blood and maintain the pH
regulate blood composition and urine

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5
Q

Type of pain from kidney stones

A

Colicky pain

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6
Q

Where are the three places of constriction at the ureters?

A

Pelvic ureteric junction (entering kidney - PUJ),
Pelvic brim - crossing the iliac vessels
Bladder wall - (uretero-vesical jct UVJ/VUJ) where the ureter enters the bladder

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7
Q

What are the three layers of the ureters?

A

Outer: fibrous tissue
Middle: muscle tissue
Inner: epithelium

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8
Q

What is the blood supply to the ureters?

A

Relevant to local region: renal/lumbar/gonadal, internal iliac, superior vesical

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9
Q

What are the lymphatics to the ureters?

A

Left ureter drains into left para-aortic nodes
Right ureter drains into right paracaval and interaortocaval nodes

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10
Q

What is the nerve supply to the ureters?

A

Autonomic nervous system

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11
Q

Variations in kidney anatomy

A

Single kidney
Horseshoe kidney
ectopic kidney

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12
Q

Variations in ureter anatomy

A

Partial duplication
Complete duplication

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13
Q

What is the urinary bladder?

A

Muscular reservoir of urine

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14
Q

What (location) type of organ is the bladder, and why?

A

When empty - pelvic organ.
When full - abdominopelvic organ (when bladder distends it rises into abdominal cavity)

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15
Q

What are the three layers of the bladder?

A

Outer: loose connective
Middle: smooth muscle and elastic fibres
Inner: transitional epithelium, which allows it to retain waterproof properties w/o losing functions

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16
Q

What is the arterial blood supply to the bladder?

A

Superior and Inferior vesical branches of internal iliac artery

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17
Q

At what vertebral level do the kidneys sit

A

Hilum of the kidney at L1

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18
Q

Why do kidney stones cause colicky pain

A

Ureters peristalse urine to the bladder, cause build up and let down of pain

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19
Q

What is the nerve supply to the bladder?

A

Autonomic nervous system

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20
Q

Venous drainage of the urinary bladder

A

vesical plexus which drains into the internal iliac vein

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21
Q

What is the lymphatic drainage of the bladder

A

internal iliac nodes to paraaortic nodes

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22
Q

Female urethra

A

Carries urine from the bladder to the external urethral meatus in the vaginal vestibule (in front of the vaginal orifice)

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23
Q

External urethral sphincter - female

A

skeletal muscle with voluntary guarding
pudendal nerve

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24
Q

What is the blood supply to the female urethra?

A

Internal pudendal,
Inferior vesical branches of vaginal vessels

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25
Q

What are the lymphatics to the female urethra?

A

Proximal: internal iliac nodes
Distal: superficial inguinal nodes

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26
Q

What is the nerve supply to the female urethra?

A

Proximal: Vesical plexus
Distal: pudendal nerve

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27
Q

Function of the prostate gland

A

sexual structure that secretes seminal fluid
allows ejaulate to coagulate in the vagina and liquify to allow sperm to escape

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28
Q

Bladder neck

A

Sphincter controlled by the sympathetic nervous system
stays shut during ejaculation to allows semen to flow correctly/ prevent urination

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29
Q

Where is the prostate found?

A

Below bladder, surrounds proximal part of urethra

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30
Q

How many parts does the prostate have, and what are these?

A

3 - Left Lateral, Middle, Right Lateral

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31
Q

External urethral sphincter - male

A

Tonic contraction, opens for ejac
pudendal nerve

32
Q

What is the blood supply to the prostate?

A

Inferior vesical artery

33
Q

What is the blood supply to the male urethra

A

Prostatic: Inferior vesical artery
Membranous: bulbourethral artery
Spongy: internal pudendal artery

34
Q

What are the lymphatics to the male urethra?

A

Prostatic & Membranous: obturator + internal iliac nodes
Spongy: deep and superficial inguinal nodes

35
Q

What is the nerve supply to the male urethra?

A

Prostatic plexus

36
Q

What are the two phases of micturition?
(MC)

A

Storage and Voiding

37
Q

What happens in storage (MC)

A

Bladder relaxed - acts as reservoir
Sphincter contracts - prevents leaks

38
Q

What happens in voiding (MC)

A

Bladder contracts - urination
Sphincter relaxed - allows release

39
Q

What area of the brain is responsible for urination

A

Prefrontal cortex which sends messages to the pontine micturition centre in the brainstem

40
Q

What is the innervation involved in stimulating bladder voiding?

A

Prefrontal cortex -> pontine micturition centre ->
Parasympathetic nucleus - sacral spinal cord s2-4 (bladder contraction)
Onuf’s nucleus (sphincter relaxation)

41
Q

What is the function of the periaqueductal gray in micturition

A

Receives sensory info from viscera (vessels, gut, genitals) and sends priority info to the cortex
Tells the cortex when bladder is starting to get full

42
Q

Function of the prefrontal cortex in micturition

A

Plans ahead in terms of the best time to pee

43
Q

Function of the pontine micturition centre

A

Coordination of spinal nuclei

44
Q

Where are the nuclei responsible for micturition located

A

Sacral spinal cord S2-4
parasympathetic - detrusor
Onuf’s - sphincter

45
Q

Role of the thoracic spinal cord in micturition

A

Contains the sympathetic nucleus which controls the bladder neck
T10-L2

46
Q

How are adults and infants micturition different with regards to nervous control?

A

Infants - micturition is a local spinal reflex (release at certain pressure)
Adults - voiding controlled by higher centres for appropriate time to urinate

47
Q

Pelvic organ nerve supply - Female

A

PNS - Bladder
SNS - Kidney, testicle, bladder neck
Pudendal - penis

48
Q

Pelvic organ nerve supply - Male

A

PNS - Bladder
SNS -
Pudendal - Vaginal vestibule

49
Q

Drug target for the bladder neck

A

alpha adrenergic receptors - a blockers

50
Q

Drug target for the detrusor

A

Cholinergic M2/M3 - antimuscarinic
B adrenergic receptors - B agonist (sympathetic receptors)

51
Q

What is incontinence

A

Involuntary loss of fluid

52
Q

What is stress urinary incontinence

A

Involuntary leakage on exertion (increased abdominal pressure) - sneezing/coughing
Common in women

53
Q

What are the risk factors for stress urinary incontinence?

A

Ageing, Obesity, Smoking, Pregnancy - damage to pelvic floor muscles

54
Q

What is the theorised pathology for stress urinary incontinence?

A

Impaired bladder + urethral support - issues w/ urethral closure

55
Q

What are the investigations for stress urinary incontinence?

A

Positive stress test (exercise and see if leakage) Urodynamics (increase intraabdominal pressure -cough- and monitor for leakage)

56
Q

What is the conservative management of stress urinary incontinence?

A

pelvic floor exercises to strengthen support of bladder and urethra
^ muscle tone

57
Q

What is the surgical management of stress urinary incontinence?

A

Mid-urethral sling, supports the urethra
periurethral bulking agents

58
Q

What is an overactive bladder?

A

Urinary urgency, associated with nocturia and (not always) urgency urinary incontinence

59
Q

What are the risk factors for an overactive bladder?

A

Age, Prolapse, BMI, IBS, Bladder Irritants (caffeine, nicotine, alcohol)

60
Q

What is the theorised pathology for an overactive bladder?

A

Involuntary detrusor contractions - either idiopathic or neurogenic (loss of descending inhibitory pathways)

61
Q

What are the symptoms of an overactive bladder

A

urgency
frequency
nocturia
urgency incontinence
may lead to anxiety/depression

62
Q

What are the investigations for an overactive bladder?

A

Assess for enlarged prostate or prolapse
exclude Infection w/ dipstick
Bladder diaries
Urodynamics
Assess post void residual

63
Q

What is the initial management of an overactive bladder?

A

Behavioural/lifestyle changes (irritants), Bladder retraining physiotherapy

64
Q

What is the medical management of an overactive bladder?

A

Anticholinergics (antimuscarinic drugs - inhibit M3 so no detrusor contractions)
Beta-3 agonists (stimulate detrusor relaxation)
BOTOX (inject into detrusor, prevent contraction)

65
Q

What is the surgical management of an overactive bladder?

A

Augmentation cystoplasty (bowel restitched to bladder to increase volume)
Urinary diversion (diverting urine into bowel)

66
Q

What is BPH?

A

Benign Prostatic Hyperplasia - non malignant growth of prostate tissue

67
Q

Rectal exam findings with BPH

A

Outward enlargement of the prostate

68
Q

What is a physiological risk factor of BPH?

A

Testosterone converted to DHT (promotes prostatic growth)
.: age is an increasing risk factor

69
Q

What symptoms are there in BPH and why?

A

Lower urinary tract symptoms (hesitancy urinating, poor stream, increased frequency) as prostate compresses on urethra

70
Q

What are other differentials that should be eliminated when investigating BPH?

A

Bladder/prostate cancer, UTI, Urinary retention

71
Q

What are the urine investigations in BPH?

A

Urine disptick, Post void residual, Voiding diary

72
Q

What are the bloods done in BPH?

A

PSA - may be elevated in prostate cancer

73
Q

Imaging for BPH

A

USS of the upper renal tracts

74
Q

What is a serious complication from BPH and how can it occur?

A

Chronic Renal Disease - bladder distention leads to painless urinary retention, can lead to upper tract obstruction causing renal impairment > chronic renal disease

75
Q

What are the lifestyle managements for BPH?

A

Weight loss, reduce fluid intake in evening, avoid constipation

76
Q

What are the medical managements for BPH?

A

Alpha blocker - prevents prostate smooth muscle contraction, relaxing muscle tone
5-alpha reductase inhibitor - prevents conversion of testosterone to DHT preventing prostate growth

77
Q

What is the surgical management of BPH?

A

Transurethral resection of prostate - debulks prostate to allow channel for urine flow

Uro (7 decks)

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