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Y2 Urology & Renal Medicine > Urinary incontinence & BPH > Flashcards

Urinary incontinence & BPH Flashcards

1
Q

What is the normal diameter of a ureter?

A

3mm

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2
Q

What are the 3 sites of constriction in a ureter?

A

Pelvic-ureteric junction
Pelvic brim
Entrance to bladder

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3
Q

What are the three layers of the ureter? (sup to deep)

A

Outer fibrous tissue
Middle muscle layer
Inner epithelium layer

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4
Q

What is the blood supply to the ureters?

A

Related to the region
Renal/lumbar/gonadal/common iliac
Internal iliac
Superior vesical arteries

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5
Q

What is the lymphatic drainage of the ureters?

A

Left: left para-aortic nodes
Right: right paracaval & interaortocaval lymph nodes

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6
Q

What is the nerve supply of the ureters?

A

Autonomic nervous system

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7
Q

What are the 3 layers of the bladder? (sup to deep)

A

Outer loose connective tissue
Middle smooth muscle & elastic fibres
Inner transitional epithelium

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8
Q

What is the blood supply to the male bladder? (arterial and venous)

A

Arterial: superior & inferior vesical branches of internal iliac artery

Venous: prostatic plexus -> internal iliac vein

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9
Q

What is the blood supply to the female bladder?

A

Arterial: superior & inferior vesical branches of internal iliac artery

Venous: vesical plexus -> internal iliac vein

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10
Q

What is the lymphatic drainage of the bladder in the F GU system?

A

Internal iliac nodes -> para-aortic nodes

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11
Q

What is the nerve supply of the bladder in the F GU system?

A

ANS

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12
Q

Describe the two urethral sphincters in the F GU in terms of their control

A

Internal urethral sphincter - detrusor muscle, involuntary control
External urethral sphincter - skeletal muscle, voluntary control

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13
Q

How long is the female urethra?

A

3-4 cm

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14
Q

How long is the male urethra?

A

20 cm

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15
Q

What is the blood supply to the female urethra?

A

Internal pudendal arteries
Inferior vesical branches of vaginal arteries

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16
Q

What is the lymphatic drainage of the female urethra?

A

Proximal - internal iliac nodes
Distal - superficial inguinal nodes

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17
Q

What is the nerve supply to the female urethra?

A

Vesical nerve plexus and pudendal nerve

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18
Q

Where is the prostate gland found?

A

Underneath bladder
Surrounds prostatic urethra

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19
Q

What is the function of the prostate?

A

Secrete 75% of seminal fluid to liquify coagulated semen after deposition in the female genital tract

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20
Q

What are the 3 parts of the prostate?

A

Left lateral lobe
Right lateral lobe
Middle lobe

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21
Q

What is the blood supply to the prostate?

A

A: Inferior vesical artery

V: Prostatic plexus -> vesical plexus -> internal iliac vein

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22
Q

What is the lymphatic drainage of the prostate?

A

Internal iliac and sacral nodes

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23
Q

What is the nerve supply of the prostate?

A

ANS

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24
Q

What are the 3 parts of the male urethra?

A

Prostatic
Membranous
Spongy

25
Q

What is the blood supply to the male urethra?

A

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

26
Q

What is the nerve supply to the male urethra?

A

Prostatic plexus

27
Q

What are the two phases of micturition?

A

Filling phase
Voiding phase

28
Q

Describe the filling phase of micturition

A
  1. Bladder fills & distends without rise in intravesical pressure
  2. Urethral sphincter contracts
29
Q

Describe the voiding phase of micturition

A
  1. Bladder contracts
  2. Urethral sphincter relaxes
30
Q

What receptors are stretched in the bladder as it fills?
Where are they found?
Which spinal nerves activate them?
What neurotransmitter is used?
Which branch of the ANS is involved?

A

M3 receptors
On detrusor muscle
S2-4
ACh
Parasympathetic

31
Q

What is the action of the parasympathetic fibres on the bladder

A

Activation of M3 receptors & contraction of the detrusor muscle
Inhibition & relaxation of internal urethral sphincter

32
Q

What receptors are activated after the voiding phase?
Which spinal nerves are involved?
What neurotransmitter is used?
Which branch of the ANS is involved?

A

Beta-3 receptors
T11-L2
Noradrenaline
Sympathetic

33
Q

What is the definition of stress urinary incontinence?

A

Involuntary urinary leakage on effort or exertion (e.g. sneezing, coughing)

34
Q

What are the risk factors for stress urinary incontinence?

A

Age
Obesity
Smoking
Pregnancy & route of delivery

35
Q

What is the pathology behind stress urinary incontinence?

A

Impaired bladder and urethral support
Impaired urethral closure
Urethral hypermobility

36
Q

What investigations should be done to diagnose stress urinary incontinence?

A

Positive stress test (demonstrate loss of urine when coughing etc)
Urodynamics

37
Q

What are urodynamics?

A

Catheterise patient
Pressure line placed in rectum and bladder
Cough/increase intra-abdo pressure
See if detrusor muscle contracts as well

38
Q

How can urodynamics be used to diagnose stress urinary incontinence?

A

Urinary leakage seen during increase in intra-abdo pressure with absence of detrusor contraction

39
Q

What are the non-surgical and surgical management options for stress urinary incontinence?

A

Non-surgical: physio (pelvic floor exercises)
Surgical: mid-urethral sling, colposuspension, periurethral bulking agents

40
Q

What is urge urinary incontinence?

A

Urinary urgency, usually with increased frequency and nocturia, with or without incontinence

41
Q

What are the risk factors for urge incontinence?

A

Age
Prolapse
Increased BMI
IBS
Bladder irritants (caffeine, nicotine)

42
Q

What is the pathology behind urge incontinence?

A

Involuntary detrusor muscle contractions
Causes: idiopathic, neurogenic or bladder outlet obstruction

43
Q

What are the signs and symptoms of urge incontinence?

A

Increased urgency, frequency and nocturia
Urgency incontinence
Impact on QoL - sleep disorders, anxiety, depression

Signs:
Enlarged prostate
Prolapse in women

44
Q

What investigations can be done for urge incontinence?

A

Urine dip to exclude infection
Voiding diaries to record volumes drank and urinated
Ultrasound for post void residual volume
Urodynamics
Cystoscopy of bladder

45
Q

What management can be done for urge incontinence?

A

Lifestyle (smoking, caffeine, alcohol)
Physio (aim to pee every 3 hours)
Antimuscarinic drugs
Beta-3 agonists
Botox into detrusor muscle
Neuromodulation (stimulation of S3 or posterior tibial nerve)
Surgical (urinary diversion into bowel, augmentation cystoplasty)

46
Q

What is overflow incontinence?

A

Leakage of urine due to over-full bladder

47
Q

What are some causes of overflow incontinence? (5)

A

Outlet obstruction (faecal impaction, BPH)
Drugs (anticholinergics, sedatives, alpha adrenergics)
Iatrogenic (bladder denervation post-surgery)
Urethral/bladder neck stricture
Underactive detrusor muscle

48
Q

What is continuous incontinence? What are some causes?

A

Continuous loss of urine at all times
Causes - vesicovaginal fistula, ectopic ureter

49
Q

What is functional incontinence? What are some causes?

A

Bladder function normal
Caused by severe cognitive impairment or mobility limitations e.g. dementia

50
Q

What is benign prostatic hyperplasia? What are the risk factors?

A

Non-malignant hyperplasia of prostate tissue

Risk factors: effects of testosterone on prostate

51
Q

What is the pathology of BPH? How can it affect urination?

A

Hyperplasia of all 3 lobes of prostate gland
Compression on urethra = bladder outflow obstruction

52
Q

What are some signs & symptoms of BPH?

A

Hesitancy in starting urination
Poor stream
Dribbling post-micturition (incomplete emptying)
Frequency, nocturia
Acute retention

53
Q

What investigations can be done in BPH? (6)

A

Urine dip
Post void residual volume (ultrasound)
Voiding diary
Blood tests
Urodynamics
Cystoscopy

54
Q

What blood test can be used to diagnose BPH?

A

PSA (prostate-specific antigen)

55
Q

What lifestyle management options are there for BPH?

A

Weight loss
Reduce caffeine & fluid intake in evening
Avoid constipation

56
Q

What medical management options are there for BPH?

A

Alpha-blocker
5-alpha reductase inhibitor (prevents conversion of testosterone into DHT)

57
Q

How do alpha blockers work in BPH?

A

Alpha 1 adrenergic receptors are present on prostate stromal smooth muscle and bladder neck
Blockage of receptors results in relaxation

58
Q

How do 5-alpha reductase inhibitors work in BPH?

A

Prevents conversion of testosterone to DHT
DHT promotes growth of prostate
Results in shrinkage

59
Q

What are some surgical management options for BPH?

A

Transurethral resection of prostate

Y2 Urology & Renal Medicine (3 decks)

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