Microurition Flashcards
(32 cards)
1
Q
Explain how micturition physiology works
A
- Bladder sends a message to the brainstem via S2,3,4 – keeps everything of the floor
- There is a sensory feedback through pelvis nerves to the micturition centre which asks the rain if it is socially acceptable to pee
- Brain decides sits and weights
- Sends a message through the pudendal nerve (somatic – something we control) S2,3,4 to the sphincter
- Opens the sphincter
- Reflex action to the parasympathetic system to the bladder
- Can close pelvic floor voluntarily
- Or push harder using abdominal muscles \cannot change bladder function as it is a smooth muscle
- Sympathetic supply to the bladder – hypogastric – blood vessels in the bladder
- Parasympathetic squeeze – and about erections
2
Q
describe the storage phase of bladder filling and describe the emptying phase
A
bladder filling
- detrusor muscle relaxes
- internal sphincter constricts
- pelvic floor contracts
emptying
- detrosur contractions
- internal sphincter relaxes
- pelvic floor relaxes
3
Q
what phase does the bladder spend most of its time in
A
- spends most of its time in the storage mode
4
Q
How often does a normal 70Kg adult micturates
A
4 times/24 hours passing 1500mls of urine
5
Q
how long does each micturition take
A
- It takes 1 minute to complete so the bladder contracts for only 0.3% of 24 Horus
6
Q
what is normal bladder contraction stimulated by
A
- it is caused by release of ACh from cholinergic nerves
- this stimulates muscarinic receptors on the detrusor smooth muscle
7
Q
what does LUST stand for
A
Lower urinary tract symptoms
8
Q
what are the types of lower urinary tract symptoms
A
- Storage irritative symptoms – frequency, nocutria, urgency, urgency incontinence
- Voiding (obstructive) symptoms – hesitancy, straining, poor flow, intermittency, incomplete emptying – also terminal dribbling, dysuria, haematuria (blood in urine)
- Overactive bladder (to do with storage symptoms)– urgency with or without incontinence usually with frequency and nocutira
9
Q
how do you diagnose lower urinary tract symptoms
A
- Symptom history (acute/chronic, fever, haematuria, trauma)
- Personal history (smoker, occupation, family history)
- Past medical history (cardiovascular medicatios/anticoagultnts, previous cancer)
- Physical examination (vitals, abdominal, external genitalia, external genitalia, DRE)
10
Q
who is the international prostate symptom score scored by and why is this important
A
- by the patient
- this is reproducible as well as you can see how the score as changed once you provide intervention
11
Q
what factors make up the international prostate symptom score
A
- incomplete emptying
- frequency
- incontinency
- urgency
- weak stream
- straining
- nocturia
12
Q
what are the levels of the internal prostate symptom score
A
mild 0-7
- Reassure
- Watch and wait
- Reassess regularly
Moderate 8-19 severe 20-35 Based on QOFL score - Low QOFL -w atch and wait - Med to high QoFL – lifestyle and education, medication, surgery
13
Q
what investigations can you carry out
A
- Inspect fresh urine sample
- Urine dipstick/urine M C and S
- FBC/UandEs/PSA
- Uroflowmetery and post void residual volume
- Urodynamics (Pressure/flow studies)
- XR KUB
- Ultrasound KUB and TRUS prostate
- CT KUB
- Nuclear imaging
14
Q
what is flow rate recording
A
- this records how fast your flow rate is - the patient pees in the funnel and it measures the flow rate
15
Q
as you get older…
A
urinary flow decreases
16
Q
what are the disorders grouped into
A
can be - anatomical - functional - medical or - outlet - pump - control - constituents
17
Q
name some disorders of
- anatomical
- functional
- medical
A
- Anatomical disorders – obstructive, incontinence
- Functional disorders – stroke, spinal cord injury, neurologic disease, idiopathy
- Medical disorders – cardiac, hepatic and renal failure
18
Q
name some disorders of
- outlet
- pump
- control
- constituents
A
- Outlet – bladder neck, prostate, stricture (women rarely get this – underactive bladder is more common), meatus, foreskin
- Pump 0 bladder – OAB, sensory, failure, cardiac, medications (antipsychotics can do this)
- Control – neurology – stroke, spina bifida, cord injury, MS, tumour, Parkinson’s
- Constituents – UTI, cancer, inflammation, stones (ureteric stones and bladder stones)
19
Q
name some - storage - voiding - both or neither symptoms
A
storage
- incomplete emptying
- frequency
- urgency
voiding
- intermittency
- weak stream
- straining
both or niether
- nocturia
20
Q
why does BPH grow inwards and obstruct the bladder
A
- Humans have a capsule on the prostate like an orange therefore it can only grow so far therefore it can grow inwards and obstructive the urinary tract
21
Q
what is end fill overacitivyt
A
as the bladder is obstructive the bladder over a period of time starts to do its own thing and gets excited near the time it needs to pass urine
22
Q
what is the management of BPH and LUTS
A
Fluid - Type - Amount Bladder drill - pass urine every 4 hours, try to get them to do that Food Smoking Urethral milking Pads and convenes Not catheters – last resort and CISC best type
23
Q
what is fluid management
A
- 1500-2500ml
- use a voiding diary
- dry to hold for 4 hours at a time
- record what you drink and how much
24
Q
what can cause irritant to the bladder
A
- food and smoking
food such as champagne, chicken liver, onion, curry
25
what is urethral milking
- this is when there is a U band in the uretra
- the penis is suspended by a suspenocyory ligament
- urine can get trapped in U band therefore if you lift penis up it can help remove the trap
26
describe medical therapy that can be used for LUST and BPH
- Alpha blockers- Tamsulosin, doxazosin, terazosin – helps symptoms – works on small prostate
- 5 alpha reductase inhibitors – finasteride, Dutasteride – work on large prostate shrink the bread back
- PDE5 inhibitors
- Anitmuscarinocs for OAB
- Combination
27
what is the surgery for LUTs
- TURP – electic loop to carve out prostatic chips, 1:10 risk of transfusion, TUR syndrome, erection issues
- HoLEP/Greenlight – modern laser operation, better at tissue remoal, 1;100 risk of transufion, no TUR syndrome, fewer erection issues, expensive, HoLEP any size
- UroLift – newest technique, pruelry mechanical, preserves erections, 5 year data only, has to be the right shape prostate ad less than 80ml
- prostatic artery embolism - via a vascular route - has caused a penile embolism and parietal bladder embolism
- rezum - any shape prostate, steam therapy, no vertical issues - reoperatuion for 20% in 3 years
28
what is urinary urgency
- this can happen with or without incontinence - this is when there is stress on the bladder or an urge problem
29
what is a stress urinary incontinence and what is an urge urinary incotinenace
- Stress UI – leakage on effort or exertion (increased abdonomial pressure)
- Urge UI – leakage accompanied by urgery
- Mixed UI – both
30
what is the treatment for urinary incontinance and urge
```
Treatment
- Always treat the overactive component first
Conservative measures
- Fluid intake
- Caffeine and stimulants
- Pads
- Timed voiding
Pelvic floor exercsies – short term use
- Tablets
- Posterior tibial nerve sitmulation
- Botox
- Sacral nerve stimualtin
- Surgery
```
31
what tablets and drugs can you take for OAB/urge incontiance
anticholinergics - such as oxybutynin, solifenacin, tolterodine, fesoterodine
- this blocks acetylcholine in parasympathetic nerves
- blocks elsewhere too like salivary glands
b3 adrenegics such as mirabegron
- B3 adrenoreceptors unregulated in OAB
- hypertension may be an issue
Botulminun Toxin A (BOTOX)
- fuses synaptic vesicles with motor end plate
- issues with hyper continence
32
describe where the lesions are in the bladder and what can that mean
- Lesions above the pontine micturition centres are safe e.g. coordinated – CVA, parkinsons, brain injury, MS
- Lesions in between are unsafe – uncoordinated and thereofre high pressures in the resting bladder results – trauma, tumours, spina bifida
- Lesions below T12 are safe as bladder and sphincter are flaccid and at low pressure
