Micturition

Question 1

Is the female or male bladder at higher pressure and why

Answer 1

Male - needs higher pressure to get urine out longer urethra

Question 2

Is the male or female bladder larger

Answer 2

Female

Question 3

What causes the bladder to reflexively squeeze

Answer 3

Sphincter opening

Question 4

What innervation does the micturition centre sent out

Answer 4

Parasympathetic to detrusor
Somatic to sphincter

Question 5

How are the pelvic nerves involved in the micturition reflex

Answer 5

Sensory feedback from bladder to micturition centre
Parasympathetic from micturition centre to detrusor muscle

Question 6

What spinal routes are the pudendal nerve and pelvic nerves involved in the micturition reflex

Answer 6

S2 3 4

Question 7

2 stages of the bladder cycle

Answer 7

Storage phase
Emptying phase

Question 8

What stage of the bladder cycle is the bladder in the majority of the time

Answer 8

Storage phase

Question 9

How much urine does the average adult pass in a day

Answer 9

1.5 litres

Question 10

Why do emptying phase abnormalities in the bladder cycle not cause permanent damage to ureters and kidneys (except no function at all)

Answer 10

Phase is too short

Question 11

How can chronic retention with overflow cause kidney failure

Answer 11

Urine transferred back up into ureters and kidney

Question 12

What type of receptors are stimulated to contract the detrusor muscle

Answer 12

Muscarinic ACh receptors

Question 13

Storage LUTS

Answer 13

Frequency
Nocturnal
Urgency
Urge incontinence

Question 14

Voiding LUTS

Answer 14

Hesitancy
Straining
Poor flow
Intermittency
Incomplete emptying

Question 15

General LUTS

Answer 15

Terminal dribbling
Dysuria
Haematuria

Question 16

Overactive bladder

Answer 16

Urgency usually with frequency and nocturnal, sometimes with incontinence

Question 17

How does an enlarged bladder sound on percussion

Answer 17

Dull

Question 18

Why does the cardiovascular system affect the urinary system

Answer 18

Delivers fluid to urinary tract

Question 19

What diagnostic tool is used to urinary tract problems

Answer 19

IPSS - international prostate symptom score
Input/output charts

Question 20

What IPSS scores are mile, moderate, and severe

Answer 20

Mild - 0-7
Moderate - 8-19
Severe - 20+

Question 21

Urinary tract investigations

Answer 21

Inspect urine sample
Urine dipstick
Urine culture and sensitivity
FBC
PSA
uroflowometry
Post voidable residual volume
Urodynamics
XR
Ultrasound
CT
Nuclear imaging

Question 22

How does urinary flow rate change with age

Answer 22

Decrease

Question 23

What causes end fill over activity

Answer 23

Bladder obstruction

Question 24

3 types of micturition disorders

Answer 24

Anatomical
Functional
Medical

Question 25

Causes of obstruction

Answer 25

Benign prostatic hypertrophy Stones Structures Valves Phimosis Cancer

Question 26

Causes of incontinence

Answer 26

Stress Urge Mixed urinary incontinence

Question 27

Why does benign prostatic hyperplasia contract the urethra

Answer 27

Capsule around prostate gives prostate nowhere else to go

Question 28

Lifestyle changes for LUTS

Answer 28

alter fluid type/amount Bladder drills Change foods Stop smoking Urethral milking Pads and convenes

Question 29

Why does caffeine increase bladder contraction

Answer 29

Releases calcium stored in Golgi apparatus of bladder walls

Question 30

Why do some drinks such as coke and cranberry juice increase urination

Answer 30

Acidification irritates bladder

Question 31

Drugs used for LUTS

Answer 31

alpha blockers 5 alpha reductase inhibitors PDE5 inhibitors Antimuscarinics

Question 32

How do 5 alpha reductase inhibitors reduce constriction of urethra in men

Answer 32

Interfere with testosterone metabolism reducing prostatic hyperplasia

Question 33

How do alpha blockers reduce urethra constriction in men

Answer 33

Prevent activation of alpha adrenergic receptors in urethra muscle preventing contraction and lumen narrowing

Question 34

What is TURP

Answer 34

Electric loop carves out prostatic chips

Question 35

What is HoLEP

Answer 35

Laser removal of prostatic tissue

Question 36

What is UroLift

Answer 36

Mechanical technique to pull prostate tissue away from urethra

Question 37

What is prostatic artery embolisation

Answer 37

Blocking arteries to prostate causing gland to shrink

Question 38

What is rezum

Answer 38

Steam therapy

Question 39

Types of urinary incontinence

Answer 39

Stress UI Urge UI mixed UI

Question 40

How can urge incontinence be medically treated

Answer 40

Medication

Question 41

How can stress incontinence be treated

Answer 41

Surgery

Question 42

Urinary incontinence non-lifestyle treatments

Answer 42

Drugs Posterior tibial nerve stimulation Botox Sacral nerve stimulation Surgery

Question 43

Drugs for urge incontinence

Answer 43

Anticholinergics Beta3 andrenergics Botulinum toxin A

Question 44

How can beta3 adrenergics help urge incontinence

Answer 44

Beta3 adrenoreceptor upregulates in OAB

Question 45

How can Botox help urge incontinence

Answer 45

Fuse synaptic vessels to motor end plate

Question 46

How can anticholinergics help urge incontinence

Answer 46

Block ACh in parasympathetic nerves preventing bladder contraction

Question 47

Why can anticholinergics cause dry mouth

Answer 47

Block ACh in salivary glands

Question 48

Stress UI treatment

Answer 48

Pads Fluid intake Treat OAB Kegal excercises Vaginal cones Mid urethral slings Colposuspension

Question 49

Lesions at what level of the micturition pathway are unsafe and can damage the bladder and kidneys

Answer 49

Between pontine micturition centre and T12