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2 Physiology LUTS BPH Flashcards

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1
Q

What is micturition?

A

Process by which urine is voided from the urinary bladder through the urethra

Micturition is a key physiological process in urinary function.

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2
Q

Define urinary continence.

A

Ability to delay and execute micturition in appropriate social and hygienic conditions

This ability is crucial for social interactions and personal hygiene.

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3
Q

What are the three layers of the bladder wall?

A
  • External adventititious layer (partly covered by peritoneum)
  • Intermediate layer muscle (detrusor)
  • Inner mucous layer (lamina propria and urothelium)

The structure of the bladder wall is essential for its function.

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4
Q

What is the length of the male urethra?

A

18-20 cm

The length varies among individuals but is generally consistent.

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5
Q

What are the parts of the male urethra?

A
  • Spongious urethra (bulbar + pendula)
  • Membranous urethra (urethral sphincter)
  • Prostatic urethra

Each part has distinct anatomical and functional roles.

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6
Q

What role does the prostate play in micturition?

A

The prostate in male has an important role in micturition

It contributes to the mechanics and control of urine flow.

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7
Q

What is the function of the pubo-urethral ligament?

A

Links the urethra to the posterior side of the pubis

This ligament provides support to the female urethra.

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8
Q

What neurotransmitter is involved in parasympathetic innervation for micturition?

A

Acetylcholine (ACh)

It activates muscarinic receptors leading to detrusor contraction.

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9
Q

What receptors are involved in sympathetic innervation of the bladder?

A
  • Alfa 1 adrenergic receptor
  • Beta 3 adrenergic receptor

These receptors regulate bladder neck contraction and detrusor relaxation.

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10
Q

What is the storage phase in micturition?

A

Inhibition of the parasympathetic and stimulation of sympathetic nerves
* 150-250 ml leads to micturition stimulus
* 400 ml leads to imperative micturition stimulus
* >700 ml leads to incoercible and painful urination

The storage phase is critical for bladder function and control.

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11
Q

What occurs during the voiding phase of micturition?

A

Parasympathetic stimulation (detrusor contraction) and inhibition of somatic nerves

This phase is essential for the expulsion of urine.

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12
Q

What factors can affect bladder compliance?

A

Reduced compliance or low elasticity can lead to augmented micturition frequency and incontinence

Compliance is crucial for normal bladder function.

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13
Q

What are Lower Urinary Tract Symptoms (LUTS)?

A
  • Symptoms of the filling bladder phase (day and/or night pollakiuria, urinary urgency, urinary incontinence)
  • Symptoms of the emptying bladder phase (hesitancy, hypovalid or interrupted flow)
  • Post-voiding symptoms (post-voiding dribbling, increased residual urine volume)

LUTS can significantly impact quality of life.

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14
Q

What are common causes of LUT obstruction?

A
  • Cancer in urethra, bladder, prostate
  • Urethral stones

These conditions can severely affect urinary function.

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15
Q

What is acute urinary retention (AUR)?

A

The sudden incapacity to empty the bladder

AUR can be secondary to acute prostatitis or urethral calculus.

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16
Q

What is chronic urinary retention (CUR)?

A

Condition of incomplete emptying of the bladder after urination

CUR often results from prolonged obstruction.

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17
Q

What are the pharmacological causes of urinary retention?

A
  • Antipsychotics
  • Antidepressants
  • Anti-hypertensives
  • Anticholinergics
  • Opioids

Medications can significantly influence urinary function.

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18
Q

What is benign prostatic hyperplasia (BPH)?

A

Hyperplasia of the prostate leading to urinary obstruction

BPH is a common condition in older males, affecting urination.

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19
Q

What does BPH stand for?

A

Benign Prostatic Hyperplasia

BPH is characterized by hyperplasia of the epithelial and stromal components of the prostate gland.

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20
Q

What age group has high prevalence of BPH?

A

Men over 45 years old

The prevalence of BPH increases progressively from 30 years old, reaching up to 90% in the ninth decade of life.

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21
Q

What is the main histological change in BPH?

A

Hyperplasia of both glandular and stromal tissue

All structures of the gland increase in volume and number, involving hypertrophy and hyperplasia.

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22
Q

What factors contribute to the development of BPH?

A
  • Intrinsic factors (interaction between epithelium and stroma)
  • Extrinsic factors (hormonal, neurological, immune, dietary, and genetics)

The major cause is an alteration in the local balance between estrogen and androgens.

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23
Q

True or False: BPH is a malignant condition.

A

False

BPH is a benign condition despite causing symptoms related to urinary obstruction.

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24
Q

What is the role of testosterone in BPH?

A

Stimulates cell growth leading to prostate hyperplasia

An increase in dihydrotestosterone (DHT) contributes to cell growth and hypersensitivity to testosterone.

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25
What is the hypertrophy phase in BPH?
Gradual and progressive hyperplasia of the detrusor muscle ## Footnote This phase involves detrusor thickening as the bladder compensates for obstruction.
26
What are some symptoms of the filling phase in BPH?
* Urinary urgency * Pollakiuria (day and/or night) * Urgency incontinence ## Footnote These symptoms are typical of the second phase with fibrosis.
27
What are signs of the voiding phase in BPH?
* Urinary hesitation * Hypovalid flow * Interrupted flow * Extended voiding time ## Footnote These symptoms indicate difficulties in emptying the bladder.
28
What is paradoxical ischuria?
Overflow incontinence ## Footnote This occurs when the bladder is unable to empty completely, leading to involuntary leakage.
29
What clinical history assessments are used for BPH diagnosis?
* Micturition diary * Questionnaires * Urine test * Flowmetry * Abdominal ultrasound * Trans-rectal ultrasound * PSA * Flexible urethrocystoscopy ## Footnote These assessments help evaluate the severity and impact of symptoms.
30
What does an IPSS score greater than 16 indicate?
Possible obstruction ## Footnote The International Prostate Symptom Score (IPSS) helps assess the severity of urinary symptoms.
31
What is the normal urinary flow rate shape?
Bell-shaped curve ## Footnote The Qmax should be over 15 mL/s for a normal flow rate.
32
What are the stages of BPH classification?
* Stage 0: Clinical or histological alterations affecting the bladder * Stage I: BPH with minimal detrusor thickening; paucisymptomatic * Stage II: BPH with marked detrusor thickening and moderate/severe symptoms * Stage III: BPH with anatomical alterations including bladder diverticula or stones * Stage IV: BPH with chronic urinary retention and bilateral hydronephrosis ## Footnote Each stage reflects the severity and impact of BPH on urinary function.
33
What is the significance of PSA testing in BPH?
To evaluate the presence of cancer ## Footnote PSA levels can indicate prostate cancer risk, especially in patients with BPH symptoms.
34
What does digital rectal examination (DRE) assess in BPH?
Size and characteristics of the prostate ## Footnote DRE is useful for detecting abnormalities in the prostate gland.
35
What is a diverticulum in the context of urinary pathology?
A diverticulum is a pouch or sac that forms in the bladder due to pathologies like vescica da forzo, often associated with effortful urination. ## Footnote A diverticulum can complicate urinary function and may lead to other issues like infections.
36
What are the stages of uncomplicated PBH?
Stages 0-II PBH, with: * Stage 0: no therapy * Stage I: no therapy * Stage II: pharmacological therapy * Surgery if symptoms are severe ## Footnote PBH stands for Benign Prostatic Hyperplasia.
37
What defines complicated PBH?
Stage III-IV PBH associated with: * Diverticula * Bladder stones * Recurrent urinary infections * Chronic urinary retention (CUR) ## Footnote Complicated PBH may require surgical intervention.
38
What are the main classes of medical therapy for PBH?
* Alpha blockers * 5-alpha reductase inhibitors (5-ARIs) * Phytotherapy * Antimuscarinics * Beta-3 agonists * Phosphodiesterase-5 inhibitors (PDE5is) ## Footnote Each class targets different symptoms and mechanisms of urinary obstruction.
39
What is the mechanism of action for alpha blockers in treating PBH?
Alpha blockers reduce the contractile state of intra-prostatic musculature without altering detrusor contractility, improving urinary flow. ## Footnote Common alpha blockers include Silodosin, Tamsulosin, and Doxazosin.
40
What are the potential side effects of alpha blockers?
* Hypotension * Retrograde ejaculation ## Footnote Retrograde ejaculation occurs due to relaxation of the bladder neck during ejaculation.
41
What is the function of 5-alpha reductase inhibitors (5-ARIs)?
5-ARIs convert testosterone into dihydrotestosterone, reducing prostate volume and alleviating urinary obstruction. ## Footnote Examples include Dutasteride and Finasteride.
42
What are the side effects of 5-alpha reductase inhibitors?
* Erectile dysfunction * Decrease in libido * Gynecomastia ## Footnote Effects may take up to 6 months to manifest due to cellular action.
43
What is the purpose of combination therapy in PBH treatment?
Combination therapy uses alpha blockers and 5-ARIs to address both dynamic and static components of obstruction when mono-therapy fails. ## Footnote This approach can enhance treatment effectiveness.
44
What are the main indications for surgical therapy in PBH?
* Urinary retention * Impaired kidney function due to obstruction * Recurrent hematuria * Bladder stones * Bladder diverticulosis ## Footnote Surgical intervention is imperative in these cases.
45
What is Transurethral Resection of the Prostate (TURP)?
TURP is an endoscopic technique used to remove prostate tissue, primarily for glands sized 30-80 cc. ## Footnote It is considered the gold standard for surgical treatment of BPH.
46
What is Holmium Laser Enucleation of the Prostate (HoLEP)?
HoLEP is an endoscopic procedure that enucleates the adenoma and morcellates it for removal, indicated for prostate volumes greater than 80 cc. ## Footnote This technique offers a minimally invasive option for larger prostates.
47
What does HoLEP stand for?
Holmium Laser Enucleation of Prostate
48
What is the indication for HoLEP?
Prostate volume > 80cc
49
What instrument is used for morcellation during HoLEP?
Morcellator
50
What is the purpose of a morcellator in HoLEP?
Creates very small pieces that can be aspirated
51
What is the maximum prostate volume that HoLEP can be used for?
More than 100cc
52
What does ThuLEP stand for?
Thulium Laser Enucleation of Prostate
53
What is the main advantage of KTP laser (Green Laser) in prostate procedures?
Photoelectrically vaporizes adenomatous tissue with less bleeding
54
True or False: KTP laser allows for histological examination of tissue.
False
55
What are common complications of surgical therapy for prostate issues?
* Bladder stones * Bladder diverticula
56
What is the indication for adenomectomy?
Patients with prostate volumes greater than 100cc
57
What is the urethra stenosis rate after an endoscopic procedure?
4-5%
58
What is the urethra stenosis rate after a surgical approach?
Up to 10%
59
What is the main problem with robot-assisted pure adenomectomy?
Cost, up to 5-10 thousands
60
What is the goal of new minimally-invasive approaches for prostate treatment?
Efficient treatment with less morbidity and shorter or no hospitalization
61
What is Prostatic Artery Embolization (PAE)?
An interventional radiological procedure that induces atrophy of gland tissues
62
What is one significant risk associated with PAE?
Collateral side effects by damaging nearby structures
63
What is the mechanism of action for REZUM therapy?
Uses water vapor energy to disrupt cell membranes and reduce prostate volume
64
What must be maintained after REZUM therapy to prevent acute urinary retention?
A catheter for at least a week
65
What does iTIND stand for?
Implantable nitinol device
66
What is the purpose of the iTIND device?
Creates incisions in tissue to reduce urinary flow obstruction
67
What is UROLIFT?
An implantable device that creates a channel from the bladder neck to the veru montanum
68
What is the major risk associated with UROLIFT?
Risk of clips migration or hematoma formation
69
What is Aquablation?
A robotic-guided endoscopic technique using high-pressure water jet to ablate adenoma
70
What is a potential complication following Aquablation?
Risk of bleeding due to blood vessels destruction without coagulation
71
How does Aquablation identify the prostate and adenoma?
Using a probe in the rectum to indicate to the software
72
What is a common outcome after Aquablation treatment?
Alteration in ejaculation

urology (17 decks)

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