💧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
