💧Urology💧- Urinary Tract - Incontinence & Symptoms Flashcards
What are the components of the urinary tract?
2 Kidneys, 2 ureters, urinary bladder, urethra
Ureters convey urine from kidneys to bladder
What is the blood supply of the kidneys?
renal/lumbar/gonadal/common iliac, internal iliac and superior vesical arteries with corresponding venous drainage
What are the variations in kidney anatomy?
Single kidney (1% of population)
Horse-shoe kidney
Ectopic kidney
What are the common ureter variations?
Partial duplication
Complete duplication
What are “hold up” points in the ureter?
Constriction points may block urine flow, especially if a kidney stone dislodges and becomes a ureteric stone (pain, ipsilateral impaired renal function)
Where are the potential hold up points in the ureter?
Where the renal pelvis joins the top of the ureter- pelvic ureteric junction (PUJ, or UPJ)
Pelvic brim, crossing the iliac vessels
As it passes through the bladder wall; uretero-vesical junction (UVJ, or VUJ)
What is the urinary bladder?
Reservoir of urine
Stores, does not respond to pressure like other organs by extension
Where is the bladder in the body?
When empty, bladder is in the pelvis, when distended it is an abdomino-pelvic organ
Outline the female urinary tract
Urethra carries urine from bladder to the external urethral meatus in the vaginal vestibule
External urethral sphincter- skeletal muscle, tonic contraction and also voluntary “guarding”. Controlled by pudendal nerve
What is the blood supply of the female urinary tract?
Internal pudendal arteries and inferior vesical branches of the vaginal arteries with corresponding venous drainage
What are the lymphatics and inntervations of the female urinary tract?
Proximal urethra into internal iliac nodes, distal urethra to superficial inguinal lymph nodes
Vesical plexus (proximal), pudendal nerve (distal)
Why is the trigone further forward in females?
Pushed forward by uterine cervix
Outline the male urinary tract
The bladder neck; a sphincter which stays shut except when voiding. Controlled by the sympathetic nervous system
Prostate gland
External urethral sphincter- tonic contraction/ guarding. Opens for ejaculation. Controlled by pudendal nerve
What is the blood supply for the male urinary tract?
Prostate - inferior vesical artery, urethra- bulbourethral artery and internal pudendal artery with corresponding venous drainage
What are the lymphatics and innervations of the male urinary tract?
Prostatic and membranous urethra drain to obturator and internal iliac nodes, spongy urethra to deep and superficial inguinal nodes
Vesical plexus (proximal), pudendal nerve (distal)
What are the main differences between the male and female urinary tracts?
Extra anatomical sphincter-bladder neck
Need both genito and urinary set up, cos sphincter open when urinating and ejaculating
Presence of prostate
Shares tract with genitals
What is retrograde ejaculation?
Not expelling sperm, going back in bladder, cloudy pee in postcoital bladder relief
What is the micturition cycle?
Describe the neural control of micturition?
Prefrontal cortex permits the pontine micturition centre in the brainstem to change from storage mode to voiding
This activates the parasympathetic nucleus (bladder contraction), and inhibits Onuf’s nucleus (sphincter relaxation)
Why is epilepsy often associated with urinary incontinence?
via limbic stimulation
What is supplied by the PNS?
Bladder
What is supplied by the SNS?
Kidney
Testicles
Bladder Neck
What is innervated by the pudendal nerve?
Penis
Vaginal vestibule/clitoris
What are the autonomic receptor drug targers in the pelvic organs?
Bladder Neck:
α-adrenergic (α-1) receptor blockers → e.g., tamsulosin
Detrusor Muscle:
Cholinergic M3/M2 (Antimuscarinic) → e.g., oxybutynin, solifenacin
β-adrenergic β-3 agonist → e.g., mirabegron
Erectile Function:
Nitric oxide pathway → PDE5 inhibitors
What is the definition of urinary incontinence?
Any involuntary loss of urine
What is stress urinary incontinence?
Complaint of involuntary leakage on effort or exertion, or on sneezing or coughing
Incidence:
can affect up to 40% of women, more common in older women, with 1 in 5 women over 40 having some degree of stress incontinence
What are the risk factors for stress urinary incontinence?
Age
Obesity
Smoking
Pregnancy
What is the pathology of stress urinary incontinence?
Impaired bladder and urethral support and impaired urethral closure
What are the investigations for urinary incontinence?
History and examination; descent of pelvic floor on vaginal examination, positive stress test (visible loss of urine on inspection).
Urodynamics
What are the management options for stress urinary incontinence?
Non-surgical: physiotherapist teaching pelvic floor muscle exercises.
Surgical:
Sling placed to support the urethra
Using the anterior vaginal wall to support the urethra (colposuspension)
Periurethral bulking injection
What is the definition of an overactive bladder?
urinary urgency, usually with urinary frequency and nocturia, with or without urgency urinary incontinence
Outline overactive bladder
What are the symptoms and signs of overactive bladder?
Urgency, frequency, nocturia and urgency incontinence
Impact on QOL due to sleep disruption, anxiety and depression
Assess for enlarge prostate in males and prolapse in women
What are the investigations for overactive bladder (urge urinary incontinence)?
Exclude infection with urine dip/MSU
Bladder diary
Bladder scan (post void residual)
[Urodynamics]
What are the management options for bladder overactivity?
Behavioural/lifestyle changes
Bladder retraining
Antimuscarinic drugs
Beta-3 agonist
Bladder injections with botox
Neuromodulation
Augmentation cystoplasty
What is benign prostatic hyperplasia?
Non malignant growth or hyperplasia of prostate tissue, common cause of lower urinary tract symptoms in men
Outward enlargement can be felt with rectal exam
What is the incidence and risk factors for benign prostatic hyperplasia?
Incidence:
increases with advancing age, 50-60% for males in their 60’s, increasing to 80-90% for those over 70yrs of age
Risk factors:
hormonal effects of testosterone on prostate tissue
What is important to note about whether benign prostate growth is outward or inward?
What is the pathology f benign prostatic hyperplasia?
Hyperplasia of both lateral lobes and the median lobe, leading to compression of the urethra and therefore bladder outflow obstruction
See hyperplasia of the stroma (smooth muscle and fibrous tissue) and glands
What are the signs and symptoms of benign prostatic hyperplasia?
Hesitancy in starting urination
Poor stream
Dribbling post micturition
Can present with acute retention
What are the managements options for benign prostatic hyperplasia?
Lifestyle: weight loss, reduce caffeine and fluid intake in evening, avoid constipation
Medical:
α blocker- prostate stromal smooth muscle and bladder neck. Blocking the receptor relaxes muscle tone
5-α reductase inhibitor-prevents conversion of testosterone into di-hydro-testosterone (which promotes prostate growth)
Surgery: transurethral resection of the prostate (TURP)-debulks occluding part to produce adequate channel for urine to flow. Can also be done with laser
