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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
What are the lymphatics to the female urethra?
Proximal: internal iliac nodes Distal: superficial inguinal nodes
26
What is the nerve supply to the female urethra?
Proximal: Vesical plexus Distal: pudendal nerve
27
Function of the prostate gland
sexual structure that secretes seminal fluid allows ejaulate to coagulate in the vagina and liquify to allow sperm to escape
28
Bladder neck
Sphincter controlled by the sympathetic nervous system stays shut during ejaculation to allows semen to flow correctly/ prevent urination
29
Where is the prostate found?
Below bladder, surrounds proximal part of urethra
30
How many parts does the prostate have, and what are these?
3 - Left Lateral, Middle, Right Lateral
31
External urethral sphincter - male
Tonic contraction, opens for ejac pudendal nerve
32
What is the blood supply to the prostate?
Inferior vesical artery
33
What is the blood supply to the male urethra
Prostatic: Inferior vesical artery Membranous: bulbourethral artery Spongy: internal pudendal artery
34
What are the lymphatics to the male urethra?
Prostatic & Membranous: obturator + internal iliac nodes Spongy: deep and superficial inguinal nodes
35
What is the nerve supply to the male urethra?
Prostatic plexus
36
What are the two phases of micturition? (MC)
Storage and Voiding
37
What happens in storage (MC)
Bladder relaxed - acts as reservoir Sphincter contracts - prevents leaks
38
What happens in voiding (MC)
Bladder contracts - urination Sphincter relaxed - allows release
39
What area of the brain is responsible for urination
Prefrontal cortex which sends messages to the pontine micturition centre in the brainstem
40
What is the innervation involved in stimulating bladder voiding?
Prefrontal cortex -> pontine micturition centre -> Parasympathetic nucleus - sacral spinal cord s2-4 (bladder contraction) Onuf's nucleus (sphincter relaxation)
41
What is the function of the periaqueductal gray in micturition
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
Function of the prefrontal cortex in micturition
Plans ahead in terms of the best time to pee
43
Function of the pontine micturition centre
Coordination of spinal nuclei
44
Where are the nuclei responsible for micturition located
Sacral spinal cord S2-4 parasympathetic - detrusor Onuf's - sphincter
45
Role of the thoracic spinal cord in micturition
Contains the sympathetic nucleus which controls the bladder neck T10-L2
46
How are adults and infants micturition different with regards to nervous control?
Infants - micturition is a local spinal reflex (release at certain pressure) Adults - voiding controlled by higher centres for appropriate time to urinate
47
Pelvic organ nerve supply - Female
PNS - Bladder SNS - Kidney, testicle, bladder neck Pudendal - penis
48
Pelvic organ nerve supply - Male
PNS - Bladder SNS - Pudendal - Vaginal vestibule
49
Drug target for the bladder neck
alpha adrenergic receptors - a blockers
50
Drug target for the detrusor
Cholinergic M2/M3 - antimuscarinic B adrenergic receptors - B agonist (sympathetic receptors)
51
What is incontinence
Involuntary loss of fluid
52
What is stress urinary incontinence
Involuntary leakage on exertion (increased abdominal pressure) - sneezing/coughing Common in women
53
What are the risk factors for stress urinary incontinence?
Ageing, Obesity, Smoking, Pregnancy - damage to pelvic floor muscles
54
What is the theorised pathology for stress urinary incontinence?
Impaired bladder + urethral support - issues w/ urethral closure
55
What are the investigations for stress urinary incontinence?
Positive stress test (exercise and see if leakage) Urodynamics (increase intraabdominal pressure -cough- and monitor for leakage)
56
What is the conservative management of stress urinary incontinence?
pelvic floor exercises to strengthen support of bladder and urethra ^ muscle tone
57
What is the surgical management of stress urinary incontinence?
Mid-urethral sling, supports the urethra periurethral bulking agents
58
What is an overactive bladder?
Urinary urgency, associated with nocturia and (not always) urgency urinary incontinence
59
What are the risk factors for an overactive bladder?
Age, Prolapse, BMI, IBS, Bladder Irritants (caffeine, nicotine, alcohol)
60
What is the theorised pathology for an overactive bladder?
Involuntary detrusor contractions - either idiopathic or neurogenic (loss of descending inhibitory pathways)
61
What are the symptoms of an overactive bladder
urgency frequency nocturia urgency incontinence may lead to anxiety/depression
62
What are the investigations for an overactive bladder?
Assess for enlarged prostate or prolapse exclude Infection w/ dipstick Bladder diaries Urodynamics Assess post void residual
63
What is the initial management of an overactive bladder?
Behavioural/lifestyle changes (irritants), Bladder retraining physiotherapy
64
What is the medical management of an overactive bladder?
Anticholinergics (antimuscarinic drugs - inhibit M3 so no detrusor contractions) Beta-3 agonists (stimulate detrusor relaxation) BOTOX (inject into detrusor, prevent contraction)
65
What is the surgical management of an overactive bladder?
Augmentation cystoplasty (bowel restitched to bladder to increase volume) Urinary diversion (diverting urine into bowel)
66
What is BPH?
Benign Prostatic Hyperplasia - non malignant growth of prostate tissue
67
Rectal exam findings with BPH
Outward enlargement of the prostate
68
What is a physiological risk factor of BPH?
Testosterone converted to DHT (promotes prostatic growth) .: age is an increasing risk factor
69
What symptoms are there in BPH and why?
Lower urinary tract symptoms (hesitancy urinating, poor stream, increased frequency) as prostate compresses on urethra
70
What are other differentials that should be eliminated when investigating BPH?
Bladder/prostate cancer, UTI, Urinary retention
71
What are the urine investigations in BPH?
Urine disptick, Post void residual, Voiding diary
72
What are the bloods done in BPH?
PSA - may be elevated in prostate cancer
73
Imaging for BPH
USS of the upper renal tracts
74
What is a serious complication from BPH and how can it occur?
Chronic Renal Disease - bladder distention leads to painless urinary retention, can lead to upper tract obstruction causing renal impairment > chronic renal disease
75
What are the lifestyle managements for BPH?
Weight loss, reduce fluid intake in evening, avoid constipation
76
What are the medical managements for BPH?
Alpha blocker - prevents prostate smooth muscle contraction, relaxing muscle tone 5-alpha reductase inhibitor - prevents conversion of testosterone to DHT preventing prostate growth
77
What is the surgical management of BPH?
Transurethral resection of prostate - debulks prostate to allow channel for urine flow

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