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Year 2 Uro > Urinary Incontinence > Flashcards

Urinary Incontinence Flashcards

(55 cards)

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1
Q

What is BPH?

A

Benign Prostatic Hyperplasia

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2
Q

What is the main influencing hormone for prostate developement?

A

dihydrotestosterone

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3
Q

What are the three zones?

A

Transition: 10% of the glandular tissue of the prostate
Site of origin of benign prostatic hyperplasia

Central: 25% of the glandular tissue of the prostate

Peripheral: 65% of the glandular tissue of the prostate

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4
Q

What is the function of the prostate?

A

Liquefy ejaculate

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5
Q

What is the role of the capsule?

A

The capsule transmits the ‘pressure’ of tissue expansion to the urethra and leads to an increase in urethral resistance

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6
Q

How is active smooth muscle tone regulated?

A

by the adrenergic nervous system

⍺1A adrenoreceptor is most abundant in prostate

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7
Q

What is LUTS in men with BPH related to?

A

Obstruction induced changes, changes in bladder function rather than to outflow obstruction directly.

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8
Q

What are the two classes of symptoms of BPH?

A

Voiding

Storage

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9
Q

What is important to ask about in BPH?

A

Fluid intake

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10
Q

What comprised the BPH examination?

A 
General examination
Palpable bladder
Ballotable kidneys
Phimosis
Meatal stenosis
Enlarged prostate on DRE, size, consistency, nodules, anal tone and sensation
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11
Q

What are obstruction-induced changes?

A

Detrusor instability/↓ compliance → frequency and urgency

↓ detrusor contractility → 
Further deterioration in the force of the urinary stream 
Intermittency
Increased residual urine
Sometimes detrusor failure
Hesitancy
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12
Q

What are voiding symptoms?

A

Reduced flow
Incomplete emptying
Strangury
Hesitancy

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13
Q

What are storage symptoms?

A

Frequency (daytime and nocturia)
Urgency
Incontinence

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14
Q

What are other symptoms seen in BPH?

A

Visible haematuria

Infection

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15
Q

What investigations are done for BPH?

A 
Urine dipstick
Bladder diary
Flow rate + PVR
IPSS Questionnaire 
PSA, creatinine
Flexible cystoscopy in some circumstances
TRUS prostate
Urodynamic studies

USS KUB if impaired renal function, loin pain, haematuria, renal mass on examination

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16
Q

What is a IPSS?

A

Validated patient reported outcome measures

Specifically designed for BPH

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17
Q

What is a bladder diary?

A

Record when and how much fluid

Record volume of urine passed and when

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18
Q

What are the management options for BPH?

A

Watch and wait
Lifestyle changes
Pharmacological treatment
Surgical

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19
Q

What lifestyle changes can be made for BPH

A 
What they drink
How much they drink
Tweaks to improve urinary symptoms 
e.g. stop drinking late at night to limit passing urine at night 
cut out caffeine
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20
Q

What are some 5-alpha-reductase inhibitors?

A

e.g. Finasteride, Dustasteride

to prevent disease progression, reducing the development of AUR/requirement for surgery

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21
Q

What are some alpha-adrenergic antagonists?

A

e.g. Tamsulosin, alfuzosin, doxazosin

reduction in symptoms of 30-40% and improvement in flow rates of 16-25%

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22
Q

What are the surgical options for BPH?

A

TURP - transurethral resection of prostate

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23
Q

What is urinary incontinence?

Study These Flashcards
A

significant health problem worldwide associated with considerable social and economic impact on individuals and society

24
Q

Describe the epidemiology of UI?

Study These Flashcards
A

In women, prevalence 5-72% among community-dwelling women

It may be significantly under-reported as it is an embarrassing problem to many women

Women with SI are less likely to seek help than those with OAB

25
What is stress UI?
the complaint of involuntary leakage on exertion/sneezing/coughing/pregnancy increased intraabdominal pressure overwhelms sphincter muscles and allows urine to leak out
26
What is urge UI?
the complaint of an involuntary leakage accompanied by or immediately preceded by urgency especially at night usually uninhibited detrusor muscle
27
What is mixed UI?
the complaint of an involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing
28
What is continuous incontinence?
continuous leakage
29
What is overflow incontinence?
leakage associated with urinary retention blockage in urine flow (BPH) or ineffective detrusor can cause weak/intermittent flow or hesitancy
30
What is nocturnal enuresis?
the complaint of loss of urine occurring during sleep
31
What is Post-micturition dribble?
the complain of an involuntary loss of urine immediately after passing urine
32
What are risk factors for UI?
``` Age Pregnancy and vaginal birth Obesity Constipation Drugs e.g. ACE inhibitors Smoking FHx Prolapse/Hysterectomy/Menopause ```
33
What investigations are done for UI?
``` Urine dipstick Flow rate and post-void residual Bladder diary Pad tests Patient symptom scores/validated QoL questionnaire Urodynamic/video-urodynamic studies ```
34
What are the lifestyle changes for SI in women?
``` Weight loss Smoking cessation Modification of high/low fluid intake Supervised pelvic floor exercises Bladder re-training ```
35
What are the possible pharmacological treatments for SI?
Oestrogen therapy if there is evidence of atrophy Oral medical therapy in rare cases
36
What are the surgical options for SI?
Occlusive e.g. bulking, compressive (AUS) Supportive (mid-urethral sling, colposuspension) Ileal conduit diversion
37
What are the three causative theories of SI in men?
Sphincter incompetence Reduction in urethral sphincter length Post-operative strictures
38
What are the 5 structures that control continence?
``` Detrusor muscle Internal sphincter Ureterotrigonal muscles Levator muscles Rhabdosphincter (external sphincter muscle) ```
39
What is OAB?
Over-active bladder | Symptom syndrome
40
What symptoms comprise overactive bladder?
Urinary frequency Urgency Nocturia with or without leak
41
What are differentials surrounding UUI?
``` UTI DO Urethral syndrome Urethral divertivulum Interstitial cystitis Bladder cancer Large residual volume ```
42
What are lifestyle changes for UUI?
decreasing caffeine intake stopping smoking losing weight if obese
43
What pharmacotherapy can be used for UUI?
Efficacy is 50-75% Anti-cholinergics e.g. solifenacin, tolterodine, trospium Beta-3-agonists e.g. betmiga
44
What are the surgical options for UUI?
Posterior tibial nerve stimulation Intravesical injection of botulinum toxin A Neuromodulation Clam (augmentation) cystoplasty Urinary diversion
45
What is the efficacy for botox injections?
efficacy is 36-89%, mean efficacy is 70%, upto a mean time of 6 months
46
What is the efficacy for neuromodulation in UI treatment?
50% cure rate, 25% significant improvement of symptoms, 25% failure rate
47
What is the efficacy of clam cystoplasty?
50% cure rate, 25% significant improvement of symptoms, 25% failure rate
48
medical treatments of BPH
alpha blockers - symptom relief (relax bladder neck) | 5a reductase inhibitors (prevents test-DHT so results in shrinkage improving obstructive symptoms)
49
what is functional UI?
severe congitive impairment of mobility limitations preventing use of toilet bladder function normal
50
phases of micturition
filling phase - bladder fills/distends wtihout rise in intravesical pressure. urethral sphincter contracts and closes urethra voiding phase - bladder contracts and expels urine, urethral sphincter relaxes and urethra opens
51
what is in control of external urethral sphincter
pudendal nerve S2-4 | voluntary control in adults
52
process of micturition
M3 receptors stimulated by full bladder (parasympathetic) contraction of detrusor muscle by parasympathetic S2-4, inhibits internal urethral sphincter for bladder emptying voluntary pudendal nerve (S2-4) relaxation of external urethral sphincter once empty, sympathetic fibres (T11-L2) stimulated to activate beta-3 receptors to cause relaxation of detrusor muscle
53
lymphatic drainage of female ureters
left - paraaortic | right - paracaval and interaortocaval
54
anatomical constrictions of ureters
pelvic uteric junction pelvic brim as it passes through bladder wall
55
blood supply of bladder
superior and inferior vesical branches of internal iliac artery female drainage by vesical plexus - internal iliac vein male drainage by prostatic plexus - internal iliac vein

Year 2 Uro (5 decks)

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