Urinary incontinence & BPH COPY Flashcards
What type of nervous supply do the ureters receive?
autonomic
What type of nerve supply does the bladder have?
autonomic
Describe the muscle types and of the two sphincters in the urethra. (female)
internal urethral sphincter -> thickening of detrusor muscle, smooth muscle, involuntary control
external urethral orifice -> skeletal muscle, voluntary control
Where does the prostate gland sit anatomically in the male?
just below bladder
surrounds proximal part of urethra (prostatic urethra)
What is the function of the prostate.
- secrete 75% of seminal fluid
What is the function of seminal fluid?
- liquify coagulated semen after deposition in the female genital tract
Describe the measurements and shape of the prostate.
how is it connected to the bladder?
4x3x2cm
conical shape
connected to bladder by connective tissue.
Name the 3 parts of the prostate.
- left lateral lobe
- right lateral lobe
- middle lobe
Describe the innervation of the prostate.
autonomic
define normal miturition
the intermittent voiding of urine stored in the bladder
What are the two phases of micturition?
filling
voiding
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
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
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
What happens when the M3 receptors of the bladder become stretched and stimulated?
contraction of detrusor muscle for urination
How do the parasympathetic nerve fibres work on the internal urethral sphincter while the detrusor muscle contracts?
inhibit internal urethral sphincter -> relaxation -> bladder empties
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
Define stress urinary incontinence.
complaint of involuntary leakage on effort or exertion, or on sneezing or coughing
Is stress urinary incontinence common?
yes
up to 40% of women experience
name some risk factors for stress urinary incontinence.
ageing
obesity
smoking
pregnancy / route of delivery
What is the pathology of stress urinary incontinence?
impaired bladder and urethral support and impaired urethral closure
Define overactive bladder (urge urinary incontinence).
urinary urgency with urinary frequency and nocturia with or without urgency urinary incontinence
Name some other types of incontinence.
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
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)
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
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
name some risk factors of urge urinary incontinence
age
prolapse
increased BMI
bladder irritants (caffeine, nicotine)
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
Investigation of overactive bladder?
- exclude infection
- voiding diaries (3 day charts)
- assess post void residual
- urodynamics
- cystoscopy
Management of overactive bladder?
no cure
Describe what a voiding diary is. Why do we use it?
Can be used to investigate overactive bladder
a 3 day chart
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
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
How does BOTOX work as a treatment for urge urinary incontinence?
stops ACh release and temporarily (6-9mon) stops detrusor muscle contraction
What nerves are targeted for neuromodulation when treating urge urinary incontinence?
PTNS - posterior tibial nerve (brand from S2,3,4)
SNS - sacral nerves (S3)
What is overflow incontinence? What is is usually caused by?
What is continuous incontinence? What can it be caused by?
What is functional incontinence? What can it be caused by?
What is it caused when there is more than one type of incontinence involved?
mixed
What does BPH stand for and define it.
benign prostatic hyperplasia
- non malignant growth or hyperplasia of prostate tissue
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
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
What investigations can we do to investigate for BPH?
urine dip/MCS
post void residual
voiding diary
bloods: PSA
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
What imaging can we use to investigate for BPH?
ultrasound to assess upper renal tracts
Flow studies/urodynamics
Cystoscopy if concerned about cancer
