structure and function of the lower urinary tract part 3 W2 Flashcards
what occurs during the filling phase in a urodynamics test (normal patient)
saline put into bladder (urethral catheter)
volume infused steadily rises
urinary flow and detrusor pressure at 0
when asked to cough, intravesical and abdominal pressure spikes from 0.
what occurs during the voiding phase in a urodynamics test (normal patient)
urinary flow demonstrable
rise in intravesical and detrusor pressure
unstable bladder (detrusor overactivity incontinence) - features on urodynamics test?
spontaneous urinary flow in filling phase
spontaneous rises in detrusor activity and intravesical pressure in filling phase
genuine stress urinary incontinence features on urodynamics test?
spontaneous urinary flow when coughing
normal detrusor activity
BOO features on urodynamics test?
normal filling phase
high detrusor pressure in voiding phase
low urinary flow in voiding phase
symptoms of outflow obstruction?
“the bladder is an unreliable witness”
storage symptoms may come first, then voiding (obstructive) symptoms
then decompensation of detrusor (residual urine, chronic retention, bladder failure, renal failure)
why is renal failure a symptom of outflow obstruction
as a result of obstructive nephropathy
management of over-active bladder?
*lifestyle
*anti-muscarinics
*selective beta-3 adrenoreceptor antagonist (mirabegron)
*intradetrusor botox (if other methods fail)
lifestyle advice for overactive bladder
cut down on caffeine and alcohol
examples of anti-muscarinic therapy?
solifenacin
fesoterodine
oxybutynin
management of stress incontinence
pelvic floor exercises
weight loss
surgery (autologous rectus abdominis sling, artificial sphincter)
management of bladder outlet obstruction?
alpha-blockers (tamsulosin)
5ARI (5-alphareductase inhibitors - finasteride)
surgery (TURP, laser prostatectomy)
TURP?
transurethral resection of the prostate
