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Y2 Urology > Urinary incontinence & BPH > Flashcards

Urinary incontinence & BPH Flashcards

1
Q

Name 3 functions of the kidneys.

A
  1. remove waste products of metabolism
  2. remove excess water and salt from blood
  3. maintain pH
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2
Q

How long are the ureters and where do they is regards to the abdomen and pelvis?

A

25cm

upper half: abdomen
lower half: pelvis

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3
Q

What is the diameter of the female ureter and where are the constrictions?

A

3mm

3 places:
- pelvic ureteric junction
- pelvic brim
- as it passed thru bladder wall

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4
Q

Name the 3 layers of the ureters.

A
  • outer fibrous
  • middle muscle
  • inner epithelial
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5
Q

Where does the upper part of the ureter get blood supply?

A

renal, gonadal arteries

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6
Q

Where does the middle part of the ureter get blood supply?

A

common iliac and branches from AA

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7
Q

Where does the distal part of the ureter get blood supply?

A

superior vesical arteries

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8
Q

What does the venous drainage of the ureter correspond to?

A

the arterial supply

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9
Q

(Lymphatics) Where does the left ureter drain into?

A

left para-aortic nodes

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10
Q

(Lymphatics) Where does the right ureter drain into?

A

right para-aortic nodes and interaortocaval lymph nodes

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11
Q

What type of nervous supply do the ureters receive?

A

autonomic

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12
Q

Revise these structures

A

revise

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13
Q

Name the 4 angles of the bladder when it is empty.

A
  • apex
  • neck
  • 2 lateral angles
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14
Q

Name the 4 sides of the bladder when is in empty and in a pyramid shape.

A

base/posterior surface
2 inferiolateral surfaces
superior surface (aka, bladder dome)

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15
Q

Name the 3 layers of the bladder.

A

outer loose connective tissue
middle smooth muscle + elastic fibres
inner layer lines with transitional epithelium

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16
Q

Where does the bladder get its blood supply?

A

superior and inferior vesical branches of internal iliac artery

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17
Q

Where does the blood of the female bladder drain?

male?

A

female: drained by vesical plexus which drains into internal iliac vein

male: prostatic venous plexus which drains into internal iliac vein

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18
Q

(Lymphatics)
Where does the bladder drain?

A

internal iliac nodes
paraaortic nodes

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19
Q

What type of nerve supply does the bladder have?

A

autonomic

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20
Q

How long is the female urethra?

male?

A

3-4cm

20cm

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21
Q

Outline the course of the female urethra.

male?

A

origin: neck of bladder (aka internal urethral sphincter) ->
end: external urethral orifice

origin: neck of bladder ->
prostate gland ->
floor of pelvis ->
perineal membrane -> penis ->
end: external urethral orifice at tip of male penis

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22
Q

Describe the muscle types and of the two sphincters in the urethra. (female)

A

internal urethral sphincter -> thickening of detrusor muscle, smooth muscle, involuntary control

external urethral orifice -> skeletal muscle, voluntary control

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23
Q

Outline the blood supply of the female urethra.

A

internal pudendal arteries
inferior vesical branches of the vaginal arteries
(venous drainage corresponds)

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24
Q

(Lymphatics) Where does the proximal urethra of the female drain into?

A

internal iliac nodes

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25
Q

(Lymphatics) Where does the distal urethra of the female drain into?

A

superficial inguinal nodes

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26
Q

Which nerves supply the female urethra?

male?

A

vesical plexus and pudendal nerve

prostatic plexus

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27
Q

Where does the prostate gland sit anatomically in the male?

A

just below bladder
surrounds proximal part of urethra (prostatic urethra)

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28
Q

What is the function of the prostate.

A
  • secrete 75% of seminal fluid
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29
Q

What is the function of seminal fluid?

A
  • liquify coagulated semen after deposition in the female genital tract
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30
Q

Describe the measurements and shape of the prostate.

how is it connected to the bladder?

A

4x3x2cm
conical shape

connected to bladder by connective tissue.

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31
Q

Name the 3 parts of the prostate.

A
  • left lateral lobe
  • right lateral lobe
  • middle lobe
32
Q

Describe the arterial blood supply and venous drainage of the prostate.

A

artery: inferior vesical artery

venous: prostatic plexus to the vesical plexus and internal iliac vein

33
Q

Describe the lymphatic drainage of the prostate.

A

internal and sacral nodes

34
Q

Describe the innervation of the prostate.

A

autonomic

35
Q

revise this diagram

A

revise

36
Q

name the 3 parts of the male urethra

A
  • prostatic
  • membranous
  • spongy
37
Q

Outline the blood supply of the male urethra.

A

prostatic part:
- interior vesical artery

membranous part:
- bulbourethral artery

spongy part:
- internal pudendal artery

(w/ corresponding venous drainage)

38
Q

Describe the lymphatic drainage of the male urethra.

A

prostatic + membranous parts:
- obturator + internal iliac nodes

spongy part:
- deep + superficial inguinal nodes

39
Q

define normal miturition

A

the intermittent voiding of urine stored in the bladder

40
Q

What are the two phases of micturition?

A

filling
voiding

41
Q

Expand on the processes of the filling and voiding phases of miturition.

A

Filling:
- bladder fills and distends without rise in intravesical pressure
- urethral sphincter contracts and closes urethra

Voiding:
- bladder contracts and expels urine
- urethral sphincter relaxes and urethra opens

42
Q

Compare adult and infant micturition

A

infants: local spinal reflex (bladder empties of reaching critical pressure)

adults: voiding can be initiated or inhibited by higher centre control of the external urethral sphincter

43
Q

What receptors are stimulated as the bladder fills? What spinal nerves do these correspond to? What do these spinal nerve release to bind to the receptors in the bladder?

A

M3 receptors
parasympathetic S2-4
ACh

44
Q

What happens when the M3 receptors of the bladder become stretched and stimulated?

A

contraction of detrusor muscle for urination

45
Q

How do the parasympathetic nerve fibres work on the internal urethral sphincter while the detrusor muscle contracts?

A

inhibit internal urethral sphincter -> relaxation -> bladder empties

46
Q

Once the bladder empties and the stretch fibres of the bladder become inactivated, ______ nervous system (T__- L__) is stimulated by to activate the ____ receptors with _____, causing _____ of the detrusor muscle so that the bladder can fill again

A

sympathetic
T11-L2
beta 3 receptors
noradrenaline
relaxation

47
Q

Define stress urinary incontinence.

A

complaint of involuntary leakage on effort or exertion, or on sneezing or coughing

48
Q

Is stress urinary incontinence common?

A

yes

up to 40% of women experience

49
Q

name some risk factors for stress urinary incontinence.

A

ageing
obesity
smoking
pregnancy / route of delivery

50
Q

What is the pathology of stress urinary incontinence?

A

impaired bladder and urethral support and impaired urethral closure

51
Q

Define overactive bladder (urge urinary incontinence).

A

urinary urgency with urinary frequency and nocturia with or without urgency urinary incontinence

52
Q

Name some other types of incontinence.

A
53
Q

How can we investigate for stress urinary incontinence?

A

history + examination (demonstrable loss of urine on examination)

urodynamics (urinary leakage during an increase in intrabdominal pressure in the absence of a detrusor contraction

54
Q

How can we manage stress urinary incontinence?

A

non-surgical physio with PFE

surgical:
- mid-urethral sling or colposuspension (these 2 to reduce mobility of urethra)
- periurethral bulking agents (if we believe sphincter not working properly)

55
Q

Explain urodynamics. How can we use it to diagnose urinary stress incontinence?

A

24 hr test
urinary catheter is inserted into bladder with a thin pressure line next to it with another thin pressure line in the rectum
measurements of bladder pressures and indirect abdominal pressures.

ask patient to cough and you will see a rise in intrabdominal pressure, but no contraction of detrusor associated with urinary leakage

56
Q

Explain urodynamics. How can we use it to diagnose urinary stress incontinence?

A

24 hr test
urinary catheter is inserted into bladder with a thin pressure line next to it with another thin pressure line in the rectum
measurements of bladder pressures and indirect abdominal pressures.

ask patient to cough and you will see a rise in intrabdominal pressure, but no contraction of detrusor associated with urinary leakage

57
Q

name some risk factors of urge urinary incontinence

A

age
prolapse
increased BMI
bladder irritants (caffeine, nicotine)

58
Q

Describe the pathophysiology of urge urinary incontinence.

A

involuntary detrusor muscel contraction
can be idiopathic, neurogenic, bladder outlet obstruction or other

in general not well understood yet

59
Q

Investigation of overactive bladder?

A
  • exclude infection
  • voiding diaries (3 day charts)
  • assess post void residual
  • urodynamics
  • cystoscopy
60
Q

Management of overactive bladder?

A

no cure

61
Q

Describe what a voiding diary is. Why do we use it?

A

Can be used to investigate overactive bladder

a 3 day chart

62
Q

Why are antimuscarinic drugs used as a treatment for urge urinary incontinence?

A

M3 receptors on detrusor muscle are activated by ACh from parasympathetic fibres

bladder contracts

block the receptors and ACh can’t bind and less contraction of detrusor -> bladder

63
Q

If patients can’t tolerate antimuscarinic drugs as a treatment for urge urinary incontinence, what else can be used?

A

beta-3-agonists

beta-3 receptors which facilitate detrusor muscle relaxation

64
Q

How does BOTOX work as a treatment for urge urinary incontinence?

A

stops ACh release and temporarily (6-9mon) stops detrusor muscle contraction

65
Q

What nerves are targeted for neuromodulation when treating urge urinary incontinence?

A

PTNS - posterior tibial nerve (brand from S2,3,4)
SNS - sacral nerves (S3)

66
Q

What is overflow incontinence? What is is usually caused by?

A
67
Q

What is continuous incontinence? What can it be caused by?

A
68
Q

What is functional incontinence? What can it be caused by?

A
69
Q

What is it caused when there is more than one type of incontinence involved?

A

mixed

70
Q

What does BPH stand for and define it.

A

benign prostatic hyperplasia
- non malignant growth or hyperplasia of prostate tissue

71
Q

describe the pathology of BPH and why it leads to urinary symptoms

A

hyperplasia of both lateral lobes and the median lobes

leading to compression of the urethra

therefore bladder outflow obstruction

72
Q

Name 3 serious conditions that need to be ruled out before reaching a diagnosis of BPH

A

Bladder/prostate cancer
Cauda equina
High pressure chronic retention

73
Q

What investigations can we do to investigate for BPH?

A

urine dip/MCS
post void residual
voiding diary
bloods: PSA

74
Q

How can we used PSA to diagnose BPH?

(btw what does PSA stand for?)

A

prostate specific antigen

shown to predict prostate volume

  • use with caution, if concerned about prostate cancer

low PSA is a good marker that the prostate is normal, but high PSA can mean a number of different things

75
Q

What imaging can we use to investigate for BPH?

A

ultrasound to assess upper renal tracts
Flow studies/urodynamics
Cystoscopy if concerned about cancer

Y2 Urology (7 decks)

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