Urogynae Flashcards
What are the three categories of LUTS syx
Storage
Voiding
Post micturition
Define OAB
Urgency symptoms (frequency and nocturia) with or without urge incontinence in abscence of infection or other underlying pathology
Prevalence of OAB
13-15%
What % of pt with OAB have UUI
30% actually have leakage
List the kind of urinary incontinence in order of prevelance
SUI -> MUI -> UUI (though MUI/UUI more prevalent in elderly)
Incidence of LUTS
~40-60%
Risk factors for UI
age
Parity
MOD (forceps>SVD>CS)
Hysterectomy
Smoking
Obestity
Medical co-morbidities eg DM, CCF
Systemic oestrogen (worsens UI, while topical improves)
What nerves supplied the urethra
outer striated muscle layer = pudendal ie voluntary
Middle smooth muscle layer -> SNS (Alpha receptor NA) and PNS (nitric oxide) S2-4
Describe the layers of the urethra
3 layered cylinderical tube - outer layer, striated muscle, middle smooth muscle, inner layer = sub/mucosa
Each contribute 1/3 of the resting pressure of the urethra
Pathophys of SUI
urethral hypermobility +/- intrinsic sphincter deficiency
What are the structures that support the urethra
anterior vaginal wall (pubocervical portion of endopelvic fascia, levator ani
Causes of intrinsic sphincter deficiency
Denervation injury (scarring, ischaemia, radiation, compression during parturition of pudendal nerve)
describe nervous control of the detrusor
PNS - S2-4 M3 receptors
SNS T10-L2 -> hypogastric + pelvic plexus
B adrenergic receptions NA
Describe voiding reflex
stretch proprioceptors send afferent signal via spina cord through A delta fibres to Pontine Micturition centre, sends efferent signal via ANS to trigger micturition. Higher brain centre tonic suppresion of PMC once voluntary control of bladder taught
Types of detrusor overactivity
- Neurogenic
- Obstruction
- Idiopathic
Embryological origin of trigone
mesoderm -> forms from the mesonephric ducts (cf rest of bladder and urethra formed from endoderm - urogenital sinus)
Urodynamic stress incontinence vs stress incontinence
USI is a dx based on urodynamic assessment vs SI is a syx, or sx or dx based in clinical assessment
DO (detrusor overactivity) vs OAB (overactive bladder)
DO- urodynamic observation- involuntary detrusor contractions
OAB - clinical syndrome urgency +/- incontinence often observe DO with this
Describe the urodynamic findings in USI
concurrent rise in pressure reading in pAbd and pVes, no rise in pDet. leakage of urine corresponding to these pressure rises on flow
Describe DO on urodynamics
concurrent rise in pVes and pDet, no rise in pAdb, associated leak on flowmetry.
