Flashcards in Micturition Deck (22):
What are the 3 phases of micturition?
How is the storage phase maintained?
inhibits the sympathetic efferents (hypogastric nerve) creating a tonic contraction of the IUS and inhibiting contraction of the detrusor muscle.
How is diuresis inhibited?
Bladder fills so activates S2-S4 pelvic afferents -> signal sent to the micturition centre -> PS activation
However if conditions are not acceptable then EUS is tightened via pudendal nerve and detrusor muscle relaxed via hypogastric nerve
How does micturition occur?
PS efferents are stimulated releasing acetylcholine to act on SM muscarinic receptors allowing contraction of the detrusor muscle
Pudendal nerve and hypogastric inhibited so sphincters and detrusor muscle contracts
How much urine do you normally remove a day?
4 times a day
1500ml of urine
How is micturition diagnosed/assessed?
History, personal history, past medical history, physical exam, I-PSS
What is I-PSS?
International Prostate Symptoms Score
- involves frequency, urgency, nocturia
- assess quality of life due to symptoms
- mild: 0-7 (watchful waiting)
- moderate 8-19
- severe 20-35
What are the 3 types of symptoms you can get from the lower urinary tract?
- storage (irritative)
- voiding (obstructive)
- overactive bladder syndrome
What are some examples of storage/irratative symptoms?
frequency, nocturia, urge inctonience
What are some examples of voiding (obstructive) symptoms?
hesitance, straining, poor flow, incomplete emptying, haematuria, terminal dribbling
What are some examples of - overactive bladder syndrome?
urgency, frequency, nocturia
How do you inspect urine?
Colour and smell
Uroflowmetry (decreases with age)
What are the 3 main types of disorders? Examples of each
- anatomical (obstruction, BPH, incontinence)
- functional (stroke, spinal cord injury, neurological, idiopathic)
- medical (cardiac, hepatic, renal failure)
What are some lifestyle changes?
Food and smoking
Pads and convenes
Caffeine means more likely bladder contraction
Acidification irritates bladder
What are the main forms of medical therapy?
- alpha blockers
- 5 alpha reductase inhibitors
- PDE5 inhibitors
How do alpha blockers and 5 alpha reductase inhibitors work?
Alpha blockers - (prevent activation of alpha receptors which activate SM/enlarge urethra lumen)
5-alpha reductase inhibitors - reduce prostate growth
What are some surgical options?
- TURP - transurethral resection of the prostate
- HoLEP - laser to remove prostate
- UroLIFT - holds prostate gland out of the way
What are the types of urinary incontinence?
- urge incontinence: overactive waves (overactive bladder)
- stress incontinence (urine leaks as weakened pelvic muscles)
What are some treatments for urge incontinence?
- conservative measures (fluid intake, caffeine, pads, timed voiding, pelvic floor exercises)
- tablets (anticholinergics and beta adrenergics)
- Botox/surgery (fuses synpatic vessels with end plate for hypercontinence)
What do anticholinergics do?
Block Ach in PS nerves
ANd in other places
What do beta adrenergics do?
Upregulate beta receptors in over-reactive bladder