Urology Flashcards
1) What nervous system is the pelvic nerve part of?
2) Describe the role of the pelvic nerve in micturition.
1) Parasympathetic nervous system.
2) Releases ACh which acts on M3 receptors on the detrusor muscle, causing contraction and micturition.
1) What nervous system is the somatic nerve part of?
2) Describe the role of the pudendal nerve in micturition.
1) Somatic nervous system.
2) Releases ACh which acts on nicotinic receptors on the external urethral sphincter causing contraction and voluntary urinary retention.
1) What nervous system is the hypogastric nerve part of?
2) Describe the role of the hypogastric nerve in micturition.
1) Sympathetic nervous system.
2) Releases NA which acts on B3 receptors on the detrusor muscle causing relaxation and alpha1 receptors on the internal sphincter causing contraction. Both of these actions cause urinary retention.
1) What structural entity involved in micturition is only present in males?
2) Name the 3 nerves involved in the physiology of micturition.
1) Internal sphincter.
2) Pelvic, hypogastric, pudendal.
Describe the series of events which occur when a person has an empty bladder.
- Little stretching of detrusor.
- Slow firing from afferent fibres to spinal cord.
- Stimulation of hypogastric nerve which promotes relaxation of the bladder and internal sphincter contraction.
- Higher centres also stimulate hypogastric nerve as well as inhibiting pelvic efferents.
- Stimulation of pudendal nerve so external sphincter is voluntarily contracted.
Describe the series of events which occur when a person has a full bladder.
- Stretching of detrusor.
- Rapid firing from pelvic afferents to sacral region of spinal cord.
- Impulses projected to pontine micturition centre.
- Inhibition of hypogastric nerve causing relaxation of internal sphincter.
- Stimulation of pelvic nerve efferents causing detrusor contraction.
- Voluntary inhibition of pudendal nerve causes relaxation of external sphincter = VOIDING.
1) What is meant by the term neurogenic bladder?
2) What can cause a neurogenic bladder?
1) This is bladder dysfunction caused by neurological damage.
2) Any condition that impairs bladder and bladder outlet afferent and efferent signalling can cause neurogenic bladder.
In patients with a neurogenic bladder, there is a high risk of serious complications. Name 3 of them.
1) Recurrent infections
2) Vesicoureteral reflux
3) Autonomic dysreflexia
1) Name 3 CNS causes of neurogenic bladder.
2) Name 3 PNS causes of neurogenic bladder.
3) name 3 other causes of neurogenic bladder.
1) Stroke, spinal injury, meningomyelocoele.
2) Diabetes, alcohol, B12 deficiency, disc herniation, damage due to pelvic injury.
3) Multiple sclerosis, Parkinson’s disease and Syphilis.
1) What are the 2 types of neurogenic bladder?
2) Basically describe a spastic bladder.
3) Basically describe a flaccid bladder.
1) Spastic and flaccid.
2) Typically normal volume with small and involuntary contractions occurring.
3) Volume is typically large, pressure is low and contractions are absent.
1) What does a spastic bladder usually result from?
2) In patients with a spastic bladder, what is typically uncoordinated?
3) What eventuality often co-exists with a neurogenic bladder?
1) Usually results from brain damage or spinal cord damage above T12.
2) Bladder contraction and sphincter relaxation are typically uncoordinated.
3) Bladder outflow obstruction often co-exists with a neurogenic bladder and may exacerbate symptoms.
1) What might a flaccid bladder result from?
2) After acute cord damage, what may an initial flaccid bladder be followed by?
1) Peripheral nerve damage or spinal cord damage from S2 to S4 level.
2) Long term flaccidity or spasticity.
**Note that after acute cord damage and initial flaccidity of the bladder, there is the possibility that bladder function may improve.
Give 3 signs or symptoms of a flaccid bladder.
1) Overflow incontinence
2) Urinary retention
3) Overflow dribbling
Give 3 signs or symptoms of a spastic bladder.
1) Urgency (unless pt is lacking in sensation).
2) Frequency
3) Spastic paralysis
4) Nocturia
5) Urine leakage
In the condition detrusor muscle dyssynergia, what may prevent complete bladder emptying?
Sphincter spasm during voiding.
Name 5 investigations which might be involved in diagnosis of a neurogenic bladder.
Post void residual volume Renal USS Serum creatinine Cystography Cystoscopy Cystometrography with urodynamic testing.
** Diagnosis is usually suspected clinically which leads to further investigations.
Describe what each of the following investigations evaluates:
1a) cystography
1b) cystoscopy
1c) cystometrography
2) What can cystometrography show if it is done during spinal cord injury recovery?
1a) evaluates bladder capacity and can detect if there is ureteral reflux.
1b) evaluates severity and duration of retention and checks for BOO.
1c) determines whether bladder volume and pressure are too high or too low
2) It can evaluate detrusor functional capacity and predict rehabilitation prospects.
What can urodynamic testing of voiding flow rates with sphincter electromyography show in patients with a neurogenic bladder?
This can show whether bladder contraction and sphincter relaxation are coordinated.
Describe the 5 basic principles of management of patients with a neurogenic bladder.
1) Renal function monitoring
2) Catheterisation for a flaccid bladder
3) Control of UTIs
4) Increased fluid intake
5) Frequent position changes
What are the 3 sites of constriction in the ureters where renal stones can lodge?
1) Pelvico-Ureteric junction
2) Pelvic brim
3) Vesicoureteric junction.
1) Why do crystals in the urine usually form?
2) What may also contribute to renal stone formation?
3) Essentially, what are the crystal like structures which can form within nephrons?
1) Due to elevated levels of solutes in the urine (calcium/ uric acid/ sodium/ oxalate).
2) Decreased levels of stone inhibitors (citrate and magnesium).
3) Precipitants of some electrolytes.
Describe how renal colic pain can be caused with regards to urinary stones.
- Urinary stones can cause an obstruction.
- Obstruction within a tubule causes a build up of pressure in the tubule
- Increased pressure leads to irritation and inflammation
- Irritation and inflammation cause renal colic pain.
Describe how oedema can occur in patients with urinary stones.
- Urinary stones can get stuck at sites of constriction.
- There may be an increase in pressure proximally to the obstruction.
- The increased in pressure can cause irritation.
- Increased pressure plus irritation can cause oedema.
Describe why hyperperistalsis can occur in patients with urinary stones.
-Irritation and oedema can cause the ureter to contract more vigorously in order to try and push the stone out.
What triad of signs and/or symptoms is associated with renal stones?
Fever
Vomiting
Flank pain (acute, severe and colicky) which can radiate to the back or groin.
Aside from the triad of signs and symptoms associated with renal stone disease, give 5 other potential signs or symptoms which may occur upon clinical presentation.
Nausea Urinary frequency Urinary urgency Haematuria Proteinuria Sterile pyuria Tachycardia Renal angle tenderness if there is retroperitoneal inflammation.
**Often with renal stones, the patient cannot lie still due to the pain, which differentiates the condition from peritonitis which is aggravated by movement.
State the percentage of renal stones which are formed from the following compounds:
a) Calcium Oxalate
b) Magnesium Phosphate (struvite)
c) Urate
d) Hydroxyapatite/ Cysteine
a) 75%
b) 15%
c) 5%
d) 5%
1) In whom are struvite stones more common?
2) When are urate stones more common?
1) Struvite stones are more common in those with chronic UTIs.
2) Urate stones are more common in hot climates.
Name 5 factors which contribute towards renal stone formation.
1) Low urinary volume.
2) Abnormally low or high urine pH.
3) Ionic strength
4) Solute concentration.
5) Solute chemical interactions.
Name 7 potential risk factors for the formation of renal stones.
High protein diet High salt intake Male Caucasian Obesity Dehydration Crystaluria Fix Warm climate
Name 3 types of medication which can increase the risk of renal stone development.
Antacids
Carbonic annhydrase inhibitors
Na+/Ca2+ containing medications
