urology Flashcards
what is the normal function of the LUT?
- to convert a continuous process of excretion (urine prod) to an intermittent process of elimination
- store urine insensibly
- void urine when convenient
what does the detrusor muscle do?
relaxes during storage
contracts during voiding
what does the distal sphincter in LUT do?
contracts during storage
relaxes during voiding
what is PS control of LUT?
cholinergic
s2-4
what is S control of LUT?
noradrenergic
t10-l2
what are 2 types of LUT symptoms?
storage and voiding
what are some storage symptoms of LUT?
frequency
nocturia
urgency
urgency incontinence
what are some voiding symptoms of LUT?
hesitancy straining poor/intermittent stream incomplete emptying post micturition dribbling haematuria dysuria
what is BPH
benign prostatic hyperplasia
histological, increase in cell number
what is BPE
benign prostatic enlargement
why might BPH happen
bc of cell number increase
decrease in apoptosis
combo of 2
how are androgens liked to BPE/BPH?
don’t cause BPE
are a requirement for BPH
what do u look for in LUT history
what symptoms - storage/voiding/mix? duration PMH PSH DHx allergies symptom scoring
what do u do in a gen exam?
abdo exam external genitalia DRE focused near exam urinalysis
what investigations are there for LUT?
flow rates/residual vol
freq vol chart
imaging
PSA
what is acute retention of urine like
painful
upo 1L residual urine
normal u&e’s
pain relieved by catheterisation
what is chronic retention of urine
difficult to define
increased risk of infections/stones
what are LUT treatment aims?
improve urinary symptoms
improve QOL
reduce complications of bladder outflow obstruction
what are 3 drug treatments for LUT?
alpha-adrenergic antagonists: improves flow average
5-alpha-reductase inhibitors - inhibits conversion of testosterone to more active DHT: reduces size by 20-30%
anti-cholinergic - for overactivity
what are some indicates for surgery for LUT symptoms? (RUSHES)
Retention UTIs Stones Haematuria Elevated creatinine Symptom deterioration
what is TURP
trans-urethral resection of prostate
how do u diagnose AKI?
creatinine rise
urine output low
what is rhabdomyolysis?
serios syndrome due to muscle injury
results from death of muscle fibres - release of their contents into bloodstream
can lead to serious complications such as renal failure
what are 3 main causes of AKI?
pre-renal
intrarenal
post-renal
what are pre-renal AKI causes?
TRAUMA
- due to sudden/severe BP decrease
2 .flow obstruction to kidneys - D&V fluid loss
what are intrarenal AKI causes?
direct kidney damage
inflammation/infection
drugs
trauma
what are post-renal AKI causes
obstruction of urine flow (BPH, kidney stones, bladder injury, blood clots)
what is the most common AKI cause?
intrarenal
what is a medical emergency associated with AKI and what is its ECG finding?
hyperkalaemia
peaked t waves?
how do u manage hyperkalaemia
insulin/dextrose
IV fluid
salutamol
how do u manage AKI
identify risk factors
think abt common causes
dialysis indicators
what are some AKI risk factors?
age
comorbidities
reasons for admission
drugs
what are some indications for dialysis in AKI
pul oedema
persistent hyperkalemia
drug overdose
metabolic acidosis
what does prognosis of AKI depend on
early recognition/intervention
describe the kidneys in simple anatomical terms !
retroperitoneal organs
lie btwn t11-l3
blood supply from renal artery direct from aorta at L1
where do the ureters run?
over PSOAS muscle, cross iliac vessels at pelvic brim and insert into bladder trigone
how is urine transported down the ureter?
via peristalsis
where is pontine micturition centre n what does it do?
periaqueductal grey
coordination of voiding
where is the micturition reflex coordinated?
sacral micturition centre
what is the 2 diff reflexes after storage phase?
guarding reflex - inappropriate to void
micturition reflex - appropriate to void
where is the guarding reflex coordinated?
onus’s nucleus
what is normal adult bladder capacity
4-500ml
why does pressure remain low in the bladder?
as vol increases
pressure remains low due to “receptive relaxation” and detrusor muscle cmpliance
what happens during filling phase?
afferent pelvic nerves - slow firing signals to pons via spinal cord
S stimulation maintains detrusor muscle relaxation
somatic nerve stimulation
maintains urethral contraction
what kind of a reflex is micturition reflex?
autonomical spinal reflex
what happens for bladder emptying?
coordinated detrusor contraction with external sphincter relaxation to expel urine from bladder
positive feedback loop until all urine expelled
summarise storage
- receptive relaxation
- detrusor relaxation (sympathetic stimulation t11-l2)
- external urethral sphincter contracted (pudendal stimulation s2-4)
summarise micturition
- voluntary control from cortex and PMC
- detrusor contraction (PS stimulation s2-4)
- external urethral sphincter relaxation (pudendal inhibition s2-4)
what is the diff btwn m/f LUT symptoms?
women - incontinence
men - difficulty voiding, poor stream etc
what are some storage LUTS
frequency
urgency
nocturia
incontinence
what are some voiding LUTS
slow stream spraying intermittency hesitancy straining terminal dribble
what are some post-micturition LUTS
post-micturition dribble
feeling of incomplete emptying
what is OAB
overactive bladder
what is the diff btwn terminal and post-micturition dribble?
terminal - at end of stream
post-micturition - finish, trousers up, THEN
how many times a day is normal for urinating?
2-8x a day
how many times is it normal to go to the toilet during the night
once
define incontinence
involuntary loss of urine (failure of storage)
define urgency incontinence
associated with urgent desire to void which is difficult to defer
what is stress incontinence?
associated with coughing/straining
what is OAB? (overactive bladder)
urgency w/ frequency, w/ or w/o nocturne
how do u manage an OAB?
behavioural therapy (freq vol chart, caffeine etc)
anti-muscarinic agents
b3 agonists
botox
surgery
how do anti-muscarinics work for OAB?
why can they be bad?
decrease PS activity by blocking m2/3 receptors
BUT side effects: dry mouth
what is the main side effect associated with anti-muscarinics?
dry mouth
how do b3 agonists work for OAB?
increase sympathetic activity at b3 receptor in bladder
how does botox work for OAB?
blocks neuromuscular junction for Each release
what is stress incontinence usually secondary to in females?
birth trauma (denervation of pelvic floor, weakening of fascial support of bladder/urethra)
what is an obstructive cause for voiding problems in men?
and what is a treatment ?
BPE
give alpha blockers ± 5alpha reductase inhibitors
what does neurogenic incontinence need an understanding of?
the neurological condition and its implications
how does the prostate surround the urethra?
like a donut
what is the main function of the prostate?
to produce PSA which liquefies semen
what does PSA do
liquefies semen
what is the main biomarker for prostate cancer
PSA
what type of cancer is usually prostate cancer?
adenocarcinoma
what is PSA?
detected in small quantities in blood
prostate specific not cancer specific
elevated in BPE, prostatitis etc