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B1 > Urinary Obstruction/Altered Voiding > Flashcards

Urinary Obstruction/Altered Voiding Flashcards

1
Q

What’s the common presentation (signs and symptoms) of altered voiding?

A 
Incontinence
Urgency
Altered frequency
Nocturia
Poor stream/hesitancy
Dysuria
Retention
Incomplete emptying
Terminal dribbling
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2
Q

What’s parts of the body are included in LUT?

A

Bladder
Prostate
Urethra

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3
Q

Define urinary incontinence

A

Involuntary loss of urine in sufficient amount, or frequency to constitute a social and/or health problem

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4
Q

What can urinary incontinence lead to?

A

Morbidity/Institutionalisation
Impaired quality of life
Skin breakdown - pressure sores

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5
Q

What locations throughout the body are urinary tract obstructions likely to occur?

A

Blockages - kidney/urethra
Neuro - brain/spinal cord damage
Lower urinary tract, bladder, prostate, urethra

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6
Q

What are the 6 different types of incontinence?

A 
Stress incontinence (great pressure inside bladder - middle aged women)
Urge incontinence (overactive bladder - most common >50)
Overflow incontinence (detrusor failure/chronic retention)
Functional incontinence (doesn’t involve LUT - psychological/cognitive)
Continuous incontinence
Childhood incontinence (bed-wetting)
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7
Q

Outline the investigation, examination and management of a patient with URINARY INCONTINENCE

A 
History important (medical Hx, precipitating events, pad usage)
Examination: abdomen, genitalia, digital rectum exams
Investigations: MSU, dipstick, microscopy, cytology, FBC, U&Es, frequency volume chart, urodynamics
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8
Q

What’s urodynamics and outflow cystometry?

A

Urodynamics is the study of pressure and flow during storage, transport and expulsion of urine in the LUT - detrusor function measured at inflow and outflow to record urine flow rate/residual urine

Outflow cystometry - urethral catheter into the bladder and transducer into the rectum then record the pressures in bladder and rectum when bladder is emptied. Bladder - rectum pressure = detrusor muscle function

In both can fill bladder with/without contrast

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9
Q

What may be causes of urinary retention/obstruction?

A 
Benign prostatic hyperplasia
Prostate cancer
Prostatitis
Haematuria causing clots (bladder cancer?)
Tumours
Stones
Structural/physical/neurological
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10
Q

What’re the investigations, examinations and management for a patient with BPH?

A

International prostate symptom score classifies the symptoms

Examination: abdominal, digital rectal
Investigation: transrectal ultrasound, prostate-specific antigen

Management: alter lifestyle, doxazosin, transurethral resection of prostate

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11
Q

What are the common risk factors and causes of urinary tract stone formation?

A

Age (20-30yrs), fluid intake, diet, BMI, geography/climate

Can cause infection, chronic inflammation, malignancy
Blockage and back pressure can lead to renal failure

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12
Q

How are stones formed?

A

Crystalline growth on organic scaffold
Collisions of small crystals in urine aggregate into small stones

Crystals grow as urine supersaturated with salt and minerals - for crystal to grow it must be trapped within urine in the tract (stasis - more likely in retention)

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13
Q

What are the two most common types of stone?

A

Calcium Oxalate and Struvite

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14
Q

What’s a struvite stone?

A

Form in alkaline urine containing ammonia - caused by infection of urea-splitting bacteria
Precipitation of Mg2+, NH3, PO4

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15
Q

What’s the common presentation of urinary tract stones?

Investigation?

A

Loin to groin pain (ureteric colic)
Haematuria
Vomiting
Irritative voiding

Investigation: history, urine dipstick, urine microscopy and culture, imaging
Serum calcium and urate important

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16
Q

Why would you need to remove a urinary stone and what procedures allow this?

A

If pain/fail to pass, recurrent infection, renal impairment, obstruction, bleeding, increasing in size

Fragmentation: extracorporeal shockwave lithotripsy uses ultrasound shockwave to fragment into pieces small enough to pass

Ureteroscopic removal: ureteroscope via urethra and bladder, stones can be broken up by a laser and stent inserted to allow stone fragments to drain

Percutaneous nephrolithotomy: large stones that kidney can’t pass: kidney punctured using Xray/ultrasound guidance

17
Q

What’s overflow incontinence associated with?

A

Chronic retention (prolonged problems with emptying)
Most common in males and occurs at night
Enlarged prostate, bladder stones

18
Q

What’s urge incontinence associated with?

A

Overactive bladder - need to go immediately

Most common cause >50 years of age, usually idiopathic (maybe infection, tumour, stones, PD, dementia, stroke)

19
Q

What’s stress incontinence associated with?

A

More commonly females (weakened pelvic floor muscles after child birth)
Pressure inside bladder is greater than strength of urethra to stay closed
Involuntary urine leakage on effort/sneezing/coughing

20
Q

What will spinal cord transection above and below T12 lead to?

A

Above: reflex bladder, automatically empties as it fills

Below: flaccid bladder, detrusor paralysis so fills until abnormally distended then overflow incontinence (parasympathetic supply damaged)

21
Q

What’s functional incontinence associated with?

A

Consequence of something not involving LUT

Mobility problems/dementia/DIURETICS: FUROSEMIDE side effect

22
Q

What drug can be used for urge incontinence / overactive bladders and what’s its MOA?

A

Oxybutinin = anticholinergic to reduce detrusor activity (parasympathetic)
Blocks M2 and M3 mAChR
(Inhibits: Gq -> PLC -> IP3 -> intracellular rise in Ca2+ and therefore smooth muscle contraction)

23
Q

What drug can be used for urinary retention (BPH) and its MOA?

A

Doxasozin = a1 adrenoceptor blocker to facilitate smooth muscle relaxation
(Inhibits: Gq -> IP3 -> Ca2+ increase)

24
Q

What’s benign prostatic hyperplasia? Symptoms?

A

Enlarged prostate compresses urethra, common in >50 years
Reduced apoptosis vs increased proliferation

Hesitancy, straining, weak flow of urine, nocturia, feeling that bladder hasn’t emptied properly

25
Q

Outline the international prostate symptom score

A

7 symptoms: frequency, nocturia, incomplete emptying, hesitancy, urgency, intermittency, poor stream

Mild (0-7), moderate, severe classifications (20)

QOL question: if you were to spend the rest of your life with your urinary condition how it is now, how would you feel about that?

26
Q

What are complications of BPH?

A

Urinary tract infections
Acute urinary retention - emergency
Incontinence, erectile problems

27
Q

What should a health/cancerous prostate feel like?

A

Healthy: smooth, soft, symmetrical, regular, even
Cancer: hard, irregular, lumpy

28
Q

What are the different zones of the prostate?

A

Peripheral zone - largest and typically the one you examine

Transition zone - surrounds urethra and enlarges with age (BPH)

29
Q

How do urinary crystals form stones?

A 
Crystal growth (dependent on degree of supersaturation) -> aggregation (collision in urine)
Must be trapped within urine in urological tract
30
Q

What are the 4 places urinary stones are likely to get stuck?

A

Pelvic ureteric junction
Pelvic brim
Vesicoureteric junction
Bladder urethra outlet

31
Q

What are some causes of hypercalcuria (leading to Ca stones)

A

Idiopathic, rare genetic disorders
Hyperparathyroidism
Malignancy
Sarcoidosis + TB

32
Q

What are risk factors for struvite stone formation?

A 
All related to UTIs (urea splitting bacteria)
Female
Catheters
Neurogenic bladders
Urinary tract abnormalities
Stagnant urine
33
Q

What are 2 rare types of stone?

A

Uric acid: accumulate of urate from purine metabolism

Cystine: rare autosomal tubular disorder (cystinuria)

34
Q

What’s a serious differential for urinary stones?

A

Leaking AAA

other differentials: pancreatitis, pyelonephritis, diverticular disease

35
Q

What’s the pharmacological management of urinary tract stones?

A

Calcium stones: diuretics (FUROSEMIDE) and drugs to normalise Ca2+ homeostasis
Struvite stones: UTI antibiotics

36
Q

What is a raised PSA indicative of and what are alternative causes?

A

Prostate cancer

BPH, urinary retention, catheterisation, prostatitis, ejaculation

37
Q

What’s the initial management of stress incontience?

A

Weight reduction, stopping smoking, cut down alcohol (diuretic), avoid constipation (weakens pelvic floor muscles)

Pelvic floor exercises/training
Bladder training - careful attention to fluid and caffeine intake

38
Q

What does a urinary input/output chart tell you and why are they used?

A

Establish severity of symptoms by assessing degree of urinary frequency and at a night

When and how much fluid intake/urine passing
When and how often incontinence occurs
Assessment of volume loss due to incontinece (numbers of pads/clothing change)
Aggravating factors eg caffeine

B1 (19 decks)

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