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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
(Lymphatics) Where does the distal urethra of the female drain into?
superficial inguinal nodes
26
Which nerves supply the female urethra? male?
vesical plexus and pudendal nerve prostatic plexus
27
Where does the prostate gland sit anatomically in the male?
just below bladder surrounds proximal part of urethra (prostatic urethra)
28
What is the function of the prostate.
- secrete 75% of seminal fluid
29
What is the function of seminal fluid?
- liquify coagulated semen after deposition in the female genital tract
30
Describe the measurements and shape of the prostate. how is it connected to the bladder?
4x3x2cm conical shape connected to bladder by connective tissue.
31
Name the 3 parts of the prostate.
- left lateral lobe - right lateral lobe - middle lobe
32
Describe the arterial blood supply and venous drainage of the prostate.
artery: inferior vesical artery venous: prostatic plexus to the vesical plexus and internal iliac vein
33
Describe the lymphatic drainage of the prostate.
internal and sacral nodes
34
Describe the innervation of the prostate.
autonomic
35
revise this diagram
revise
36
name the 3 parts of the male urethra
- prostatic - membranous - spongy
37
Outline the blood supply of the male urethra.
prostatic part: - interior vesical artery membranous part: - bulbourethral artery spongy part: - internal pudendal artery (w/ corresponding venous drainage)
38
Describe the lymphatic drainage of the male urethra.
prostatic + membranous parts: - obturator + internal iliac nodes spongy part: - deep + superficial inguinal nodes
39
define normal miturition
the intermittent voiding of urine stored in the bladder
40
What are the two phases of micturition?
filling voiding
41
Expand on the processes of the filling and voiding phases of miturition.
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
Compare adult and infant micturition
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
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?
M3 receptors parasympathetic S2-4 ACh
44
What happens when the M3 receptors of the bladder become stretched and stimulated?
contraction of detrusor muscle for urination
45
How do the parasympathetic nerve fibres work on the internal urethral sphincter while the detrusor muscle contracts?
inhibit internal urethral sphincter -> relaxation -> bladder empties
46
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
sympathetic T11-L2 beta 3 receptors noradrenaline relaxation
47
Define stress urinary incontinence.
complaint of involuntary leakage on effort or exertion, or on sneezing or coughing
48
Is stress urinary incontinence common?
yes up to 40% of women experience
49
name some risk factors for stress urinary incontinence.
ageing obesity smoking pregnancy / route of delivery
50
What is the pathology of stress urinary incontinence?
impaired bladder and urethral support and impaired urethral closure
51
Define overactive bladder (urge urinary incontinence).
urinary urgency with urinary frequency and nocturia with or without urgency urinary incontinence
52
Name some other types of incontinence.
53
How can we investigate for stress urinary incontinence?
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
How can we manage stress urinary incontinence?
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
Explain urodynamics. How can we use it to diagnose urinary stress incontinence?
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
Explain urodynamics. How can we use it to diagnose urinary stress incontinence?
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
name some risk factors of urge urinary incontinence
age prolapse increased BMI bladder irritants (caffeine, nicotine)
58
Describe the pathophysiology of urge urinary incontinence.
involuntary detrusor muscel contraction can be idiopathic, neurogenic, bladder outlet obstruction or other in general not well understood yet
59
Investigation of overactive bladder?
- exclude infection - voiding diaries (3 day charts) - assess post void residual - urodynamics - cystoscopy
60
Management of overactive bladder?
no cure
61
Describe what a voiding diary is. Why do we use it?
Can be used to investigate overactive bladder a 3 day chart
62
Why are antimuscarinic drugs used as a treatment for urge urinary incontinence?
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
If patients can't tolerate antimuscarinic drugs as a treatment for urge urinary incontinence, what else can be used?
beta-3-agonists beta-3 receptors which facilitate detrusor muscle relaxation
64
How does BOTOX work as a treatment for urge urinary incontinence?
stops ACh release and temporarily (6-9mon) stops detrusor muscle contraction
65
What nerves are targeted for neuromodulation when treating urge urinary incontinence?
PTNS - posterior tibial nerve (brand from S2,3,4) SNS - sacral nerves (S3)
66
What is overflow incontinence? What is is usually caused by?
67
What is continuous incontinence? What can it be caused by?
68
What is functional incontinence? What can it be caused by?
69
What is it caused when there is more than one type of incontinence involved?
mixed
70
What does BPH stand for and define it.
benign prostatic hyperplasia - non malignant growth or hyperplasia of prostate tissue
71
describe the pathology of BPH and why it leads to urinary symptoms
hyperplasia of both lateral lobes and the median lobes leading to compression of the urethra therefore bladder outflow obstruction
72
Name 3 serious conditions that need to be ruled out before reaching a diagnosis of BPH
Bladder/prostate cancer Cauda equina High pressure chronic retention
73
What investigations can we do to investigate for BPH?
urine dip/MCS post void residual voiding diary bloods: PSA
74
How can we used PSA to diagnose BPH? (btw what does PSA stand for?)
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
What imaging can we use to investigate for BPH?
ultrasound to assess upper renal tracts Flow studies/urodynamics Cystoscopy if concerned about cancer

Y2 Urology (7 decks)

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