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BRS Y2 > Urinary Incontinence and BPH > Flashcards

Urinary Incontinence and BPH Flashcards

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1
Q

At what point during gestation does the prostate develop?

A

Weeks 10-16

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2
Q

What hormone influences prostate development?

A

Dihydrotestosterone

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3
Q

From what artery does the arterial supply to the prostate arise from?

A

Inferior vesical artery

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4
Q

What is the name of the artery that supplies the prostate?

A

Prostatic artery

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5
Q

What does the prostatic artery divide into?

A

Urethral and capsular

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6
Q

What arteries does the urethral artery give rise to?

A

Flock’s and Badenoch’s arteries

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7
Q

Where are Flock’s arteries?

A

1 and 11 o clock

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8
Q

Where are Badenoch’s arteries?

A

5 and 7 o clock

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9
Q

What undertakes the venous drainage of the prostate?

A

Peri-prostatic venous plexus

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10
Q

What does the peri-prostatic venous plexus drain into?

A

Internal iliac vein

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11
Q

Describe the lymph drainage of the prostate

A

Firstly drains to the obturator nodes and then the internal iliac chain

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12
Q

What is the set of zones of the prostate known as? name them individually top

A 
McNeal's zones:
Transition zone
Central zone
Peripheral zone
Anterior fibromuscular stroma
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13
Q

What is the function of the prostate?

A

To liquefy ejaculate

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14
Q

What does BPH stand for? What term for it would be pathologically incorrect?

A

Benign prostatic hyperplasia

You can’t call it hypertrophy

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15
Q

What condition may BPH develop into?

A

BPO= benign prostatic obstruction

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16
Q

How does BPH manifest?

A

Reduced urinary flow
Urinary frequency
Urgency
Nocturia

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17
Q

Describe the pathophysiology of BPH

A

Hihger number of epithelial and stromal cells in peri urethreal area of the prostate due to testosterone and grwoth factors
Higher urethral resistance
Compensatory changes in bladder function
Higher detrusor pressure needed to maintain urinary flow

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18
Q

What role does the capsule play in BPH?

A

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

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19
Q

How does the size of the prostate affect BPH?

A

As the size of the prostate increases so does the degree of obstruction

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20
Q

What type of tissue makes up most of the gland?

A

Smooth muscle

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21
Q

What forces increase urethral resistance?

A

Both active and passive

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22
Q

What is the most abundant adrenoceptor in the prostate?

A

⍺1A

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23
Q

What are lower urinary tract symptoms in men related to and how is this significant?

Study These Flashcards
A

They are related to obstruction induced changes in bladder function rather than directly outflow obstruction
This means even after surgical relief for BPH symptoms persist in 1/3 of men

24
Q

What are obstruction induced changes?

Study These Flashcards
A

Detrusor instability

Reduced detrusor contractility

25
What symptoms associated with voiding may arise in BPH?
Reduced flow, hesitancy, incomplete emptying, strangury
26
What symptoms associated with storage may arise in BPH?
Higher frequency (daytime and nocturia), urgency, incontinence
27
What is t very important to ask about in BPH and why?
Fluid intake as it greatly affects lower urinary tract symptoms
28
What is examined in suspected BPH and what would results be?
``` General examination Palpable bladder Ballotable kidneys Phimosis- inability to retract foreskin Meatal stenosis- abnormal narrowing of the urethral opening ```
29
What investigations can be done in BPH?
``` Urine dipstick Flow rate + PVR IPSS Questionnaire Bladder diary PSA, creatinine Flexible cystoscopy in some circumstances TRUS prostate Urodynamic studies ```
30
What conservative management can be used for BPH?
``` Watchful waiting Lifestyle changes (look at bladder diary and suggest changes such as when to stop fluid intake in the evening, cut/reduce caffeine intake ```
31
What pharmacological treatment is used to treat BPH?
Alpha adrenergic antagonists | 5 alpha reductase inhibitors
32
What surgical treatment is used to treat BPH?
Gold standard= trans urethral resection of the prostate (TURP) Embolisation Rezum- use of steam
33
What is urinary incontinence (UI)?
The complaint of any involuntary loss of urine
34
What is stress UI?
The complaint of involuntary leakage on exertion /sneezing/coughing
35
What is urge UI?
The complaint of an involuntary leakage accompanied by or immediately preceded by urgency
36
What is mixed UI?
The complaint of an involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing
37
What is continuous incontinence?
Continuous leakage
38
What is overflow incontinence?
Leakage associated with urinary retention
39
What is nocturnal enuresis?
The complaint of loss of urine occurring during sleep
40
What is post micturition dribble?
The complain of an involuntary loss of urine immediately after passing urine
41
What groups are more likely to suffer from UI?
``` Older people Pregnant and those who have had a vaginal delivery Obesity Constipation Drugs eg being on ACE inhibitors Smoking Family history ```
42
What investigations are done for UI?
``` Urine dipstick Flow rate and post-void residual Bladder diary Pad tests- the pads are weighed Patient symptom scores/validated QoL questionnaire Urodynamic/video-urodynamic studies ```
43
What groups is stress incontinence more common in?
Women of young to middle age
44
What groups is stress incontinence uncommon in?
Men who have not had prostate surgery
45
What are the 5 causative theories of stress incontinence in women?
``` Urethral causative theory Intrinsic sphincter deficiency Integral theory Hammock theory Trampoline theory ```
46
What are non surgical treatments for stress incontinence?
Lifestyle changes eg weight loss, cessation of smoking, modification of high/low fluid intake Supervised pelvic floor exercises Bladder re-training
47
What are pharmacological treatments for stress incontinence and when are they used?
Oestrogen therapy if there is evidence of atrophy | Oral medical therapy in rare cases
48
What are surgical treatments for stress incontinence?
Occlusive e.g. bulking, compressive (AUS), a material is inserted to cause a physical obstruction around the urethra or artificial sphincter holds in urine then they have to press a button to void Supportive (mid-urethral sling, colposuspension) Ileal conduit diversion
49
What are the 3 causative theories of stress incontinence in men?
Sphincter incompetence Reduction in urethral sphincter length Post-operative strictures
50
What 5 structures control continence?
``` Detrusor muscle Internal sphincter Ureterotrigonal muscles Levator muscles Rhabdosphincter (external sphincter muscle) ```
51
What are symptoms of overactive bladder (OAB)?
Urinary frequency Urgency Nocturia with or without leak
52
What are the names for oab with and without incontinence?
``` With= oab wet Without= oab dry ```
53
Which gender has a higher prevalence for oab wet vs dry?
Women have a higher prevalence for oab wet | Men have a higher prevalence for oab dry
54
What are differential diagnoses for oab?
``` UTI DO Urethral syndrome Urethral diverticulum Interstitial cystitis Bladder cancer Large residual volume ```
55
What lifestyle changes can be suggested for oab?
Decreasing caffeine intake Stopping smoking Losing weight if obese
56
What pharmacological treatment is used for oab?
Anti cholinergics | Beta 3 agonists
57
What surgical treatment can be used for oab?
Posterior tibial nerve stimulation (PTNS) Intravesical injection of botulinum toxin A Neuromodulation Clam (augmentation) cystoplasty Urinary diversion if severe

BRS Y2 (85 decks)

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