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Urogenital Y2 > L12 - Lower Urinary Tract symptoms > Flashcards

L12 - Lower Urinary Tract symptoms Flashcards

1
Q

Dyssynergia

A
  • Disturbance of muscular coordination.

- Results in uncoordinated and abrupt movement .

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2
Q

In younger men, what may be indicative of bladder outlet obstruction?

(2)

A
  1. Bladder neck dyssyngergia.

2. Static distal sphincter obstruction

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3
Q

In women, what may cause obstruction?

A

Obstruction due to urethral stricture.

Pelvic masses: ovarian or fibroids.

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4
Q

Benign prostatic hyperplasia

A

noncancerous increase in size of the prostate gland.

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5
Q

BPH may lead to…

A
  • BPH may lead to benign prostatic enlargement
  • compressing the urethra ?
  • may lead to bladder outlet obstruction
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6
Q

Describe the two categories of lower urinary tract symptoms?

A

Storage symptoms (FUN)

  • Frequency
  • Urgency
  • Nocturia

Voiding

  • Hesitancy
  • poor Urinary flow
  • intermittent flow
  • terminal dribbling
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7
Q

Bedwetting (with other symptoms) may be indicative of what?

A

High pressure chronic retention

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8
Q

What are some underlying bladder causes?

A
  1. Marked urgency

2. Bladder pain (suprapubic pain)

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9
Q

Describe the examination of a patient with suspected LUTS?

4

A
  1. Suprapubic palpation
  2. Percussion: presence of enlarged bladder
  3. Digital rectal examination: does prostate have a benign or malignant consistency?
  4. Neurological examination
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10
Q

Describe the pathophysiology behind benign prostatic obstruction?

A
  1. Obstruction due to increased tone of prostatic smooth muscle
    - sympathetic innervation
    - dynamic component
  2. Bulk effect of enlarged prostate
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11
Q

What investigations may be carried out in a patient with LUTS?

A

Uroflowmetry - max flow rate against time.

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12
Q

Give an example of where a low flow rate may be indicative of something else, rather than BOO?

A

Could be due to an underactive detrusor muscle, rather than BOO.
- pressure head bladder able to produce is low

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13
Q

Can you tell whether patient has obstruction or not just from looking at flow rate?

A

Nope, needs more complex urodynamic investigation.

Pressure and flow need to be measured.

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14
Q

Ultrasonography may show?

A

Residual urine volume

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15
Q

What is the gold standard for diagnosing BOO?

A

Pressure flow studies

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16
Q

Why might it be important to also assess patients creatinine levels?

A

Bladder pressure can lead to increased intrarenal pressure therefore damaging kidneys.

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17
Q

Why is it important to also look at serum PSA?

A

Diagnosis of prostate cancer could also alter management of patient.

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18
Q

State examples of treatment options for patients with BOO?

A

Alpha-adrenergic blocking drug

Prostate-shrinking drug (Finasteride)

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19
Q

Describe what alpha blockers do in patients with BPH and LUTS?

A
  1. Large quantities of smooth muscle in prostatic stroma BPH
  2. Tone of smooth muscle might be a factor causing obstruction
  3. Relaxes muscles of bladder and around prostate
    - so that you can pass urine more easily.
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20
Q

Describe why might Finasteride be given?

A
  1. Inhibitor of 5-alpha reductase
  2. Enzyme converts testosterone to Dihydrotestosterone (androgen)
  3. DHT will initiate prostatic growth and subsequent development of BPH.
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21
Q

What treatment options may someone with High Pressure Chronic Retention have?

A

Prostatectomy

Longterm catheterisation.

22
Q

What is a urethral stricture?

A

Scar within urethra

Due to inflammatory process or trauma

23
Q

Summarise causes of retention in women?

A
  1. Neurological
    - diabetes, MS, transverse myelitis
  2. Non-neurological
    - cystocele, rectocele, uterine prolapse, fibroids, ovarian cyst
24
Q

Transverse myelitis

A

Inflammation on both sides of one section of the spinal cord

25
Q

Cystocele

A

Prolapsing bladder which impinges on / obstructs urethra

26
Q

Rectocele

A
  • Herniation of front wall of rectum

- into back wall of vagina.

27
Q

Definition of urinary incontinence

A

Involuntary loss of urine while trying to inhibit micturition

28
Q

Describe innervation of lower urinary tract?

A 
PARASYMPATHETIC 
- S2 to S4
SYMPATHETIC 
- T10 - L2
SOMATIC / VOLUNTARY
- S2 to S4
29
Q

What occurs during bladder filling?

A
  • Bladder stores urine at low pressure.
  • Allows kidneys to continue to produce urine.
  • Sphincteric mechanism closed, providing urinary continence.
  • Detrusor relaxes
30
Q

What innervation causes voiding?

A

Parasympathetic

Simultaneous inhibition of sympathetic activity in smooth muscle of outlet of bladder.

31
Q

Describe urge incontinence

A
  • Urinary incontinence associated with extreme urgency and other filling LUTS.
  • Detrusor instability
32
Q

Describe stress urinary incontinence?

A
  • Leakage of urine when intra-abdominal pressure is raised
  • Found in post-partum women
  • brought on by coughing and sneezing
33
Q

Describe overflow incontinence

A
  • Continual loss of urine both during the day and night

- Pelvic mass or fullness in lower abdomen

34
Q

Describe continuous incontinence

caused by:

A
  • Damage to urethral sphincter mechanism

- Urinary leakage bypasses sphincter mechanism (vesicovaginal fistula)

35
Q

When is urinalysis appropriate

A

If UTI present.

Cytology: look out for malignant cells

36
Q

Patient is incontinent at night while laying supine, however dry whilst sleeping in a chair upright…

A

Patient might have postural diruesis

37
Q

Give examples of conservative measures for general stress incontinence

A
  • Weight loss
  • Pelvic floor exercises
  • reduce caffeinated drinks
38
Q

Describe how BPH may obstruct urine flow?

A
  • Enlarged prostate pushes out against urethra and bladder
  • Obstructing, blocking urine flow
  • Diagnosis made histologically
39
Q

Tamsulosin

A

Used to treat symptomatic benign prostatic hyperplasia.

Example of alpha blocker.

40
Q

What are the three components of the external urethral sphincter?

A
  1. Pubo-urethral sling (part of levator ani), striated
  2. Urethral smooth muscle - mixed autonomic
  3. External sphincter - striated
41
Q

Describe three parts of the urethra?

A

PMS
Prostatic
Membranous
Spongy (bulbar and pendulous)

42
Q

Describe an intermittent stream?

A

Urine flow stops and starts at least once during micturition

43
Q

Describe hesistancy?

A

Difficulty in initiating micturition, resulting in a delay in the onset of voiding after the individual is ready to pass urine.

44
Q

IPSS

A

International prostate symptom score

- questions concerning urinary symptoms and one question concerning quality of life.

45
Q

Frequency volume chart

A

Bladder diary.

Patient records time they get up and go to bed, fluid intake, vol of urine passed for each void. Over 3 days.

46
Q

Uroflowmetry will provide information on…

A 
Voiding time 
Maximum flow rate 
Average flow rate 
Voided volume 
Pattern of voiding curve
47
Q

What may be some sid effects of taking Finasteride 5mg

A

Reduced libido

48
Q

What may be some side effects of taking Tamsulosinn?

A
  • Postural hypotension
  • Dizziness and headaches
  • Nasal congestion
  • retrograde ejaculation
49
Q

Postural hypotension

A

Form of Low BP that happens when you stand up from sitting down.
Can make people feel dizzy or light headed.

50
Q

Retrograde ejaculation

A

Semen enters bladder isntead of emerging through the penis during orgasm.

Urogenital Y2 (16 decks)

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