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):
1

Efferent Pelvic Nerve

Acetylcholine to M3 receptor on bladder

PNS stimulation

Causes contraction of the detrusor muscle

2

Pudendal Nerve

Acetylcholine to nicotinic receptor or external sphincter

SNS

Causes sphincter contraction

Under conscious control

3

Hypogastric nerve

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

Afferent pelvic nerve

Stimulated by bladder stretch

5

Empty Bladder Physiology

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

Full Bladder Physiology

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

Voiding Reflux

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

-This triggers detrusor contraction

8

Glomerular Bleeding

Red cell casts

Dysmorphic rbcs

Proteinuria with large % albumin

9

Interstitial Cystitis

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

Transient Incontinence Causes

DIAPPERS

Delirium

Infection

Atrophic vaginitis

Pharmacology

Psychological

Excessive urine production

Restricted mobility

Stool impaction

11

Causes of excessive urine production

Excessive urine production - diuretics

Increased ADH

Polydipsia

Hyperglysuria

Hypercalcemia

12

Urge Incontinence

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

Stress Incontinence

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

Overflow Incontinence

Incomplete bladder emptying - continuous leakage

Detrusor underactivity or bladder outlet obstruction (BPH)

Tx: self-catheterizing

15

Immediate referral for Bladder Disorders

Incontinence w/ pain

UTI-free hematuria

Fistula

Complex neurological

Abnormal findings

16

Anterior and Posterior Urethral Stricture

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

Balanitis

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

Phimosis

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

Paraphimosis

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

Peyronie's Disease

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