Flashcards in Incontinence And Malignancy Deck (78):
Which nerve controls the detrusor muscle?
PNS pelvic nerves
Which nerve controls the external urethral sphincter?
Somatic pudendal nerve
Describe the positions of the external sphincter
Relaxes when voiding
How does a lower motor neurone lesion affect the bladder and anus?
Low detrusor pressure
Large volume of residual urine -> overflow incontinence
Can't feel the bladder filling
Reduced perianal sensation
Lax anal tone
How does an upper motor lesion affect the bladder?
Constantly contracting the detrusor muscle
Poor coordination with sphincters
Urine can go up, dilate the ureters and cause damage to the kidneys
How do we classify lower urinary tract symptoms?
Describe some LUT symptoms of the storage phase
Describe some LUT symptoms of the voiding phase
Describe some LUT symptoms of post-micturition
Feeling of incomplete emptying
Define urinary incontinence
The complaint of any involuntary leakage of urine
How does incontinence affect quality of life?
Social exclusion - don't want to go out
Sense of shame
What are the different types of incontinence?
Describe stress urinary incontinence
Involuntary leakage on effort/exertion or on sneezing/coughing
Describe urge incontinence
Involuntary leakage accompanied by or immediately proceeded by urgency
Describe mixed urinary incontinence
Associated with urgency and also afford/exertion/coughing/sneezing
Describe overflow incontinence
Bladder accepts more and more urine without any action
Eventually it dribbles out due to the large volume
Describe the symptoms associated with overactive bladder syndrome
What is more common, overactive bladder or urge incontinence?
Overactive bladder syndrome
Why does the prevalence of urinary incontinence increase with age?
Bladder more sensitive
Less able to hold urine
Describe how BPH affects urinary incontinence
Enlarged prostate blocks urine flow
Bladder gets larger and larger until cannot distend anymore
Starts to leak
What is the most common type of urinary incontinence?
(Due to weak pelvic floor muscles)
Give some risk factors for urinary incontinence
Increased intraabdominal pressure
What examinations would you do for someone with incontinence?
Abdominal exam (palpable bladder?)
DRE - check prostate
Females - external genitalia and vaginal exam
What is the mandatory investigation for urinary incontinence?
Check for UTI, haematuria, proteinuria, glycosuria etc
After a urine dipstick, what other investigations could you do for incontinence?
Urodynamics: frequency-volume chart, bladder diary, post-micturition residual volume (USS)
Pressure flow studies
What different factors does the management of incontinence depend on?
Degree of nuisance
Effects of treatment
What is the general advice for someone experiencing urinary incontinence?
Decreased caffeine intake
Try to regulate bowel movements
What is contained incontinence?
For patients unsuitable for surgery who have failed conservative/medical management
Describe pelvic floor muscle training
3 times a day
For at least 3 months
Patients are not usually very compliant with this
Describe how duloxetine works to treat stress incontinence
Combined adrenaline and serotonin uptake inhibitor
Increased activity in external sphincter during filling so more likely to remain closed
Has many side effects
Describe the surgical options for women with incontinence
Low tension vaginal tapes
Classical sling procedure
What are the surgical options for men with incontinence?
Artificial (hydraulic) urinary sphincter
How does an intramural bulking agent work for incontinence?
Decrease the lumen of the urethra to help retain urine
What is the short hand for prostate cancer?
What is the commonest cancer of men in the UK?
What is the usual presentation of prostate cancer?
Have localised disease
Unlikely to die of it
Urinary symptoms of BPH, bladder overactivity
Unusual to have haematuria
Give some CaP risk factors
BRCA2 gene mutation
What are the issues with PSA screening?
Quality of life
There are other causes of increased PSA
Other than cancer, what causes a raised PSA?
How do we make a diagnosis of CaP?
Digital rectal examination
What investigations do we do for CaP?
Transrectal ultrasound-guided biopsy of prostate for histology
MRI/bone scan to look for mets
If the PSA is greater than which number do we rarely consider removal?
What do we assess looking for cancer with a biopsy of the prostate?
Gleason grade (low magnification)
Extent (how involved the core is)
What are the established treatments for localised CaP?
Name some developmental treatments for localised CaP treatment
High dose rate brachytherapy
Give some treatments for metastatic prostate cancer treatment
Medical castration - given LHRH agonists
(LH and testosterone start to decrease)
Give some treatments that can help with palliative care of CaP
Single dose radiotherapy
What type of bone metastases does CaP make?
'Hot spots' on bone scans
Under which PSA are bone mets unlikely?
What are the treatments for locally advanced CaP?
Hormones and radiotherapy
Give a differential diagnosis for haematuria
Renal cell carcinoma
Upper tract transitional cell carcinoma
Advanced prostate carcinoma
What do we need to ask about in a Hx with haematuria?
Other lower urinary tract symptoms
What do we examine if someone presents with haematuria?
Leg swelling (lymphoedema)
What investigations would we carry out for someone with haematuria?
Blood - FBC, U+E
Ultrasound - any tumours or stretching
Urine - culture and cytology
Is bladder cancer commoner in males or females?
Is the incidence of bladder cancer increasing or decreasing?
What is the commonest type of bladder cancer?
Transitional cell carcinoma
Give some risk factors for bladder cancer
Occupational exposure - rubber, plastics, carbon, paint, dyes
Which type of bladder cancer is schistosomiasis linked to?
Squamous cell carcinoma
What is the treatment for bladder cancer?
Resect the tumour
Chemotherapy into the bladder
What percentage of bladder cancers are superficial on diagnosis?
How do we grade bladder cancer?
Traditional high magnification grading system
Mitotic bodies, nuclei size and ratio etc
What is the potentially curative treatment for muscle-invasive bladder cancer?
Radical cystectomy or radiotherapy
What is a radical cystectomy?
Removal of the bladder
(In women also remove the womb and ovaries)
Redirect urine to come out of the abdominal wall
95% of all upper urinary tract tumours are which type?
Renal cell carcinoma
Is the incidence of renal cell carcinoma increasing or decreasing?
Is renal cell carcinoma more common in males or females?
What percentage of renal cell carcinomas have mets on presentation?
What are the risk factors for renal cell carcinoma?
Describe the different ways renal cell carcinomas can spread
IVC spread to right atrium - forms a thrombus
What imaging can we use to diagnose renal cell carcinoma?
What are the treatments for RCC?
Describe the treatment for metastatic RCC
What are the causes of upper tract transitional cell carcinoma?
What percentage of upper urinary tract tumours are transitional cell carcinomas?
What percentage of people who develop upper urinary tract cancer develop bladder cancer?
What investigations would we do for upper tract transitional cell carcinoma?
Ultrasound for hydronephrosis
Ureteroscopy - biopsy