Bladder Disorder, Urinary Incontinence, and Penile/Urethral Disorders Flashcards Preview

Urology > Bladder Disorder, Urinary Incontinence, and Penile/Urethral Disorders > Flashcards

Flashcards in Bladder Disorder, Urinary Incontinence, and Penile/Urethral Disorders Deck (20)
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1
Q

Efferent Pelvic Nerve

A

Acetylcholine to M3 receptor on bladder

PNS stimulation

Causes contraction of the detrusor muscle

2
Q

Pudendal Nerve

A

Acetylcholine to nicotinic receptor or external sphincter

SNS

Causes sphincter contraction

Under conscious control

3
Q

Hypogastric nerve

A

SNS

Releases NE to B3 receptor on bladder

-Causes relaxation of the detrusor muscle

Releases NE to alpha-1 receptor on internal sphincter

-causes contraction of internal sphincter

4
Q

Afferent pelvic nerve

A

Stimulated by bladder stretch

5
Q

Empty Bladder Physiology

A

Slow sensory impulse to sacral -> hypogastric nerve activated (B3 and alpha1)

Pons stimulates hypogastric nerve and inhibits pelvic (M3) nerve while stimulating pudendal nerve - nicotinic for contraction

SNS stimulated, PNS inhibited

6
Q

Full Bladder Physiology

A

Urine stretches detrusor muscle - signaling the pelvic afferent nerve to increase firing

-bypasses thoracic and goes straight to pons

Pons inhibits hypogastric nerve (SNS) - no detrusor relaxation, internal sphincter relaxes, pelvic efferent stimulated causing detrusor contraction

7
Q

Voiding Reflux

A

Initiation of voiding causes pelvic afferent nerve to continue signaling sacral->interneuron->PNS efferent stimulation

-This triggers detrusor contraction

8
Q

Glomerular Bleeding

A

Red cell casts

Dysmorphic rbcs

Proteinuria with large % albumin

9
Q

Interstitial Cystitis

A

Bladder Pain Syndrome (BPS)

Usually in 4th decade

Pain w/ filling that is relieved by emptying

UA to r/o cancer or infection

Tx: education, support

-Amitriptyline, Hydroxyzine, Pentosan polysulfate sodium (PPS)

10
Q

Transient Incontinence Causes

A

DIAPPERS

Delirium

Infection

Atrophic vaginitis

Pharmacology

Psychological

Excessive urine production

Restricted mobility

Stool impaction

11
Q

Causes of excessive urine production

A

Excessive urine production - diuretics

Increased ADH

Polydipsia

Hyperglysuria

Hypercalcemia

12
Q

Urge Incontinence

A

Uninhibited contractions, detrusor overactivity, idiopathic, bladder abnormalities

Sudden urge with or after leakage

More common in men and older women

Tx: anticholinergics - increase capacity; oxybutynin for detrusor antispasmodic; miragebron for bladder relaxation

13
Q

Stress Incontinence

A

Leakage with increased intraabdominal pressure w/o bladder contractions

Seconds after cough - urethral hypermobility or intrinsic sphincter deficiency

Prostate surgery most common cause

Tx: Surgical repair

14
Q

Overflow Incontinence

A

Incomplete bladder emptying - continuous leakage

Detrusor underactivity or bladder outlet obstruction (BPH)

Tx: self-catheterizing

15
Q

Immediate referral for Bladder Disorders

A

Incontinence w/ pain

UTI-free hematuria

Fistula

Complex neurological

Abnormal findings

16
Q

Anterior and Posterior Urethral Stricture

A

Anterior: begins @ bulbar urethra, ends @ meatus

-commonly caused by straddling or penetrating injuries

Posterior: involved membranous and prostatic urethra

-commonly caused by urethral disruption via pelvic fracture

17
Q

Balanitis

A

Inflammation of glans - most common in poor hygiene or uncircumcised

Pain, irritation, itching/burning, erythema, discharge, ulceration on PE

Tx: Clean, consider circumcision; bacitracin if bacterial infection; clotrimazole if fungal infection

18
Q

Phimosis

A

Inability to retract foreskin from narrowing constriction, adhesions

Caused by balanitis, poor hygiene

erythema, itching, discharge with painful excretion/intercourse

Tx: Betamethasone cream is 1st line, circumcision 2nd

19
Q

Paraphimosis

A

retracted foreskin becomes trapped proximal to glans

Emergency - leads to ischemia of glans & gangrene

Most common in elderly

Tx: Firm compression and manual reduction, circumcision

20
Q

Peyronie’s Disease

A

Curvature of penis with erection due to plaque formation in tunica albuginea

Active phase: 1st 18-24 hours; penile pain, nodule, inflammation with some curvature

Chronic phase: stable plaque, penile angulation, loss of erectile activity

Tx: 1st 6 months - Vitamin E, ibuprofen, Colchicine

-after - Collagenase clostridium histolyticum - to break up the plaque, weekly Verapamil or surgery