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Y3 Conditions > Urinary incontinence & BPH COPY > Flashcards

Urinary incontinence & BPH COPY Flashcards

1
Q

What type of nervous supply do the ureters receive?

A

autonomic

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2
Q

What type of nerve supply does the bladder have?

A

autonomic

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3
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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4
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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5
Q

What is the function of the prostate.

A
  • secrete 75% of seminal fluid
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6
Q

What is the function of seminal fluid?

A
  • liquify coagulated semen after deposition in the female genital tract
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7
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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8
Q

Name the 3 parts of the prostate.

A
  • left lateral lobe
  • right lateral lobe
  • middle lobe
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9
Q

Describe the innervation of the prostate.

A

autonomic

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10
Q

define normal miturition

A

the intermittent voiding of urine stored in the bladder

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11
Q

What are the two phases of micturition?

A

filling
voiding

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12
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

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13
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

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14
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

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15
Q

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

A

contraction of detrusor muscle for urination

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16
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

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17
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

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18
Q

Define stress urinary incontinence.

A

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

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19
Q

Is stress urinary incontinence common?

A

yes

up to 40% of women experience

20
Q

name some risk factors for stress urinary incontinence.

A

ageing
obesity
smoking
pregnancy / route of delivery

21
Q

What is the pathology of stress urinary incontinence?

A

impaired bladder and urethral support and impaired urethral closure

22
Q

Define overactive bladder (urge urinary incontinence).

A

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

23
Q

Name some other types of incontinence.

A
24
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

25
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)

26
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

27
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

28
Q

name some risk factors of urge urinary incontinence

A

age
prolapse
increased BMI
bladder irritants (caffeine, nicotine)

29
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

30
Q

Investigation of overactive bladder?

A
  • exclude infection
  • voiding diaries (3 day charts)
  • assess post void residual
  • urodynamics
  • cystoscopy
31
Q

Management of overactive bladder?

A

no cure

32
Q

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

A

Can be used to investigate overactive bladder

a 3 day chart

33
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

34
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

35
Q

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

A

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

36
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)

37
Q

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

A
38
Q

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

A
39
Q

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

A
40
Q

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

A

mixed

41
Q

What does BPH stand for and define it.

A

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

42
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

43
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

44
Q

What investigations can we do to investigate for BPH?

A

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

45
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

46
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

Y3 Conditions (55 decks)

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