Urinary Incontinence and Benign Prostatic Hyperplasia Flashcards
(80 cards)
1
Q
What is the function of the kidneys?
A
- removes waste products of metabolism
- excess water and salts from the blood
- maintain the pH
2
Q
What anatomy is part of the female genitourinary system?
A
- 2 kidneys
- 2 ureters
- urinary bladder
- urethra
3
Q
What is the function of the ureters?
A
convey urine from the kidneys to the urinary bladder
4
Q
Where does the ureter lie?
A
upper half - abdomen
lower half - pelvis
5
Q
What is the average dimensions of the ureters?
A
- 3mm in diameter
- 25cm long
6
Q
Where is the ureter slightly constricted?
A
- pelvic ureteric junction
- pelvic brim
- passing through the bladder wall
7
Q
What are the 3 layers of tissue in the ureter?
A
- outer fibrous tissue
- middle muscle layer
- inner epithelium layer
8
Q
What is the blood supply of the ureter?
A
related to region: - renal/lumbar/gonadal/common iliac - internal iliac - superior vesical arteries (corresponding venous drainage)
9
Q
What are the lymphatic management of the ureters?
A
Left ureter: - left para-aortic nodes Right ureter: - right paracaval - interaortocaval lymph nodes
10
Q
What is the nerve supply of the ureter?
A
autonomic nervous system
11
Q
What is the bladder?
A
a muscular reservoir of urine
12
Q
Where is the bladder located?
A
empty: pelvic
full: abdomino-pelvic
13
Q
What are the layers of the bladder?
A
outer: loose connective tissue
middle: smooth muscle and elastic fibres
inner: transitional epithelium
14
Q
What is the blood supply of the bladder?
A
- superior and inferior vesical branches of the internal iliac
- drained by the vesical plexus which drains into the internal iliac vein
15
Q
What is the lymphatics of the bladder?
A
- internal iliac nodes
- para-aortic nodes
16
Q
What is the nerve supply of the bladder?
A
autonomic nervous system
17
Q
What is the female urethra?
A
channel from the neck of the bladder to the exterior (at the external urethral orifice)
18
Q
Describe the structure of the urethra at the neck of the bladder?
A
- internal urethral sphincter
- thickened detrusor muscle
- smooth muscle
- involuntary control
19
Q
Describe the structure of the urethra at the exterior?
A
- external urethral sphincter
- skeletal muscle
- voluntary control
20
Q
What is the female blood supply of the urethra?
A
- internal pudenal arteries
- inferior vesicle branches of the vaginal arteries
21
Q
What is the lymphatic system of the female urethra?
A
- proximal urethra into internal iliac nodes
- distal urethra into the superficial inguinal lymphnodes
22
Q
What is the nerve supply of the female urethra?
A
- vesical plexus
- pudendeal nerve
23
Q
What anatomy is part of the male genitourinary system?
A
- 2 kidneys
- 2 ureters
- urinary bladder
- prostate
- urethra
24
Q
What is the venous drainage of the bladder in males?
A
prostatic venous plexus which drains into the internal iliac vein
25
What is the function of the prostate?
secrete 75% of seminal fluid which liquifies coagulated semen after deposition in the female genital tract
26
Where is the prostate?
- lies below the bladder
| - surrounds the proximal part of the urethra
27
What are the 3 parts of the prostate?
- left lateral lobe
- right lateral lobe
- middle lobe
28
What is the blood supply of the prostate?
- inferior vesicle artery
| - venous drainage: prostatic plexus to the vesical plexus and the internal iliac vein
29
What are the lymphatics of the prostate?
internal and sacral nodes
30
What are the nerve supply of the prostate?
autonomic nervous system
31
Where is the urethra in males?
through:
- neck of the bladder
- prostate gland
- floor of the pelvis
- perineal membrane
- penis
- external urethral orifice
32
What are the 3 parts of the male urethra?
- prostatic
- membranous
- spongy
33
What is the blood supply of the male urethra?
prostatic: inferior vesical artery
membranous: bulbourethral artery
spongy: internal pudenal artery
(corresponding venous drainage)
34
What is the lymphatics of the male urethra?
prostatic and membranous: obturator and internal iliac nodes
| spongy: deep and superficial inguinal nodes
35
What is the nerve supply of the male urethra?
prostatic plexus
36
What is normal micturition?
intermittent voiding of urine stored in the bladder
37
What is the filling phase?
- bladder fills and distends without rise in the intravesical pressure
- urethral sphincter contracts and closes urethra
38
What is the voiding phase?
- bladder contracts and expels urine
| - urethral sphincter relaxes and urethra opens
39
How is micturition initiated in infants?
- local spine reflex in which the bladder empties on reaching a critical pressure
40
How is micturition initiated in adults?
- can be initiated or inhabited by high centre control of the external urethral sphincter keeping it closed until it is appropriate to urinate
41
What innervates the external sphincter?
the somatic motor fibre of the pudendal nerve
42
What receptors/sensory nerves are stimulated as the bladder fills?
- M3 receptors
| - parasympathetic S2-S4
43
What happens when the M3 receptors are stimulated?
- contraction of the detrusor muscle for urination
| - inhibition of the internal urethral sphincter which causes relaxation and allows for bladder emptying
44
What happens when the bladder empties?
- stretch fibres are inactivated
- sympathetic nervous system (T11-L2) activates the beta 3 receptors causing relaxation of the detrusor muscle allowing for bladder filling
45
What is stress urinary incontinence?
complaint of involuntary leakage on effort or exertion, or on sneezing or coughing
46
What is the prevalence of stress urinary incontinence?
- 40% of women
- common with age
- 1/5 women >40
47
What are the risk factors of stress urinary incontinence?
- ageing
- obesity
- smoking
- pregnancy
- route of delivery
48
What is the pathology of stress urinary incontinence?
impaired bladder and urethral support and impaired urethral closure
49
What are the signs/symptoms of stress urinary incontinence?
involuntary leakage from urethra with exertion/sneezing/coughing
50
What are the investigations for stress urinary incontinence?
- Hx and examination
- positive stress test (demonstrable loss of urine on examination)
- Urodynamics
51
What would be seen on urodynamics with stress urinary incontinence?
urinary leakage during an increase in intra-abdominal pressure in the absence of a detrusor contraction
52
What is the management of stress urinary incontinence?
- non-surgical physio with PFE
| - surgical-mid urethral sling, colposuspension and periurethral bulking agents
53
What is an overactive bladder/urge urinary incontinence?
- urinary urgency
- often with nocturia and urinary frequency
- with or without urgency urinary incontinence
(urge to urinate with an empty bladder)
54
What is the prevalence of overactive bladder/urge urinary incontinence?
16.6% in the overall population
55
What are the risk factors of overactive bladder/urge urinary incontinence?
- age
- prolapse
- increased BMI
- IBS
- bladder irritants (nicotine, coffee)
56
What is the pathology of overactive bladder/urge urinary incontinence?
- involuntary detrusor muscle contraction
- idiopathic
- neurogenic
- bladder outlet obstruction
57
What are the signs/symptoms of overactive bladder/urge urinary incontinence?
- urgency
- frequency
- nocturia
- urgency incontinence
- impact of QOL
- sleep disorders
- anxiety
- depression
- enlarged prostate
- prolapse
58
What are the investigations to confirm overactive bladder/urge urinary incontinence?
- exclude infection with urine dip
- voiding diaries
- assess post void residual
- urodynamics
- cystoscopy
59
What is the management of overactive bladder/urge urinary incontinence?
- behaviour/lifestyle changes
- bladder retaining
- anti-musancaric drugs
- beta-3 agonists
- BOTOX
- Neuromodulation (PTNS/SNS)
- Surgical: augmentation custoplasty and urinary diversion
60
What is overflow incontinence?
involuntary leakage of urine when the bladder is full, usually due to chronic retention secondary to obstruction or an atonic bladder
61
What can cause overflow incontinence?
- outlet obstruction (faecal impaction/BPH)
- underactive detrusor muscle
- bladder neck stricture
- urethral stricture
- DHx - alpha adrenergics, anti-cholinergics and sedatives
- bladder denervation post surgery
62
What is continuous incontinence?
continuous loss of urine at all time
63
What can cause continuous incontinence?
- vesicovaginal fistula
| - ectopic ureter (kidney to urethra/vagina)
64
What is functional incontinence?
- due to severe cognitive impairment or mobility limitations
- prevents use of toilet
- bladder function is normal
65
What is mixed incontinence?
- more than one type
| - seen in older patients
66
What is the definition of benign prostatic hyperplasia?
non-malignant growth or hyperplasia of prostate tissue
67
What is the incidence of benign prostatic hyperplasia?
- increases with advancing age
- 50-60% for 60
- 80-90% in >70
68
What are the risk factors fo benign prostatic hyperplasia?
hormonal effects of testosterone on prostate tissue
69
What is the pathology of benign prostatic hyperplasia?
- hyperplasia of both lateral lobes and the median lobes leading to compression of the urethra
- bladder outflow obstruction
- hyperplasia of the stroma (smooth muscle and fibrous tissue) and glands
70
What are the signs/symptoms of benign prostatic hyperplasia?
- hesitancy starting urination
- poor stream
- dribbling post micturition
- frequency, nocturia
- acute retention
71
What differentials should be excluded when benign prostatic hyperplasia is suspected?
- bladder/prostate cancer
- cauda equina
- high pressure chronic retention
- UTIs, STIs
- prostatitis
- neurogenic bladder (MS, Parkinsons)
- Urinary tract stones
- Urethral stricture
72
What investigations should be done for benign prostatic hyperplasia?
- abdominal, pelvic and rectal exam
- urine dip/MCS
- post void residual
- voiding diary
- bloods
- imaging
- flow studies/urodynamics
- cystoscopy
73
What bloods should be done to confirm benign prostatic hyperplasia?
PSA - prostatic specific antigen (predict prostate volume)
| - if cancer suspected
74
What imaging should be done to confirm benign prostatic hyperplasia?
ultrasound
| - to assess upper renal tracts
75
What is the lifestyle management of benign prostatic hyperplasia?
- weight loss
- reduce caffeine
- reduce fluid intake in the evening
- avoid constipation
76
What is the medical management of benign prostatic hyperplasia?
- alpha blocker
| - 5-alpha reductase inhibitor
77
What is the surgical management of benign prostatic hyperplasia?
transurethral resection of the prostate (TURP)
| - debulks prostate to produce adequate channel for urine flow
78
Why is an alpha blocker used in the management of benign prostatic hyperplasia?
alpha 1-AR present on the prostate stromal smooth muscle and bladder neck
- blockage causes relaxation, improving urinary flow rate
79
Why is a 5-alpha reductase inhibitor used in the management of benign prostatic hyperplasia?
- prevents the conversion of testosterone to DHT (which promotes growth and enlargement of the prostate)
- causes shrinkage, improving urinary flow rate and obstructive symptoms
80
What are the complications associated with benign prostatic hyperplasia?
```
progressive bladder distention
- causing painless chronic retention and overflow incontinence
if untreated:
- bilateral upper tract obstruction
- renal impairment
- chronic renal disease
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