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Z Year 2 BRS URO > Urinary Incontinence and BPH > Flashcards

Urinary Incontinence and BPH Flashcards

1
Q

When does the prostate develop?

A

between weeks 10-16 of gestation

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2
Q

What does the prostate develop from?

A
  • epithelial buds
  • branch out from the posterior aspect of the urogenital sinus
  • to invade the mesenchyme
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3
Q

What is the mina influencing hormone in BPH?

A

dihydrotestosterone

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4
Q

What is BPH?

A

Benign prostatic hyperplasia

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5
Q

Where does the arterial blood supply arise from in BPH?

A

inferior vesical artery

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6
Q

What does the prostatic artery divide into?

A
  1. Urethral
  2. Capsular
    group of arteries
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7
Q

What does the urethral group of arteries give rise to?

A

Flock’s and Badenoch’s arteries (both at 1 & 11 o’clock and Badenoch’s arteries approach it at 5 & 7 o’clock

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8
Q

What is the venous drainage of BPH via?

A

peri-prostatic venous plexus

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9
Q

Where does the peri-prostatic venous plexus drain?

A

internal illiac artery

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10
Q

What is the lymph drainage of BPH?

A

to the obturator nodes and then the internal iliac chain

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11
Q

What is needed from the through the production of dihydrotestosterone?

A

Stromal-epithelial interaction is important through the production of dihydrotestosterone by epithelial cells acting on mesenchymal androgen receptors

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12
Q

What is the zonal anatomy described in BPH?

A

McNeal’s zones

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13
Q

What is in the transition zone?

A
  • 10% of the glandular tissue of the prostate

* Site of origin of benign prostatic hyperplasia

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14
Q

What is in the central zone?

A

25% of the glandular tissue of the prostate

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15
Q

What is in the peripheral zone?

A

65% of the glandular tissue of the prostate

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16
Q

What is the function of the prostate?

A

Liquefy ejaculate

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17
Q

What are the different types of BPH?

A
  1. Lower urinary tract symptoms (prostatism) (LUTS)
  2. Bengin prostatic enlargement
  3. Benign prostatic hyperplasia
  4. Bladder outflow obstruction
  5. Benign prostatic obstructions
  6. Benign prostatic hypertrophy
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18
Q

What is the pathophysiology of BPH?

A
  • increased no. of epithelial and stomal cells
  • in peri-urtehral area of prostate
  • in response to androgens (testosterone) and grow factors
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19
Q

What does the increased urethral resistance in BPH lead to?

A

compensatory changes in bladder function

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20
Q

What does the increased detrusor pressure required to maintain urinary flow lead to?

A

decreased urinary flow, urinary frequency, urgency and nocturia

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21
Q

What happens to the capsule?

A

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

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22
Q

Is the size of prostate equal the degree of obstruction?

A

no

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23
Q

Why is the name BPH wrong?

A

BPH is a true hyperplastic process ie increase in cell number – the term benign prostatic hypertrophy is pathologically incorrect

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24
Q

What is a large volume of the prostate?

A

Smooth muscle

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25
Q

How can urethral resistance be increased in BPH?

A

by active and passive forces

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26
Q

What is active smooth muscle tone regulated by?

A

adrenergic nervous system

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27
Q

What is the most abundant adrenoceptor subtypes in the human prostate?

A

⍺1A

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28
Q

What is LUTS in men with BPH related to?

A
  1. Obstruction induced changes in bladder function

2. Rather than outflow obstruction directly

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29
Q

What happens to 1/3 of men with BPH and LUTS?

A

⅓ continue to have significant voiding dysfunction after surgical relief of obstruction

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30
Q

What are the obstruction induced changes in BPH?

A
  1. Detrusor instability/↓ compliance leads frequency and urgency
  2. Decreased detrusor contractility
    - leads to further deterioration in the force of the urinary stream, hesitancy, intermittency, increased residual urine and sometimes detrusor failure
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31
Q

What are the symptoms of BPH?

A
  1. Voiding
  2. Storage
  3. Other
32
Q

What is voiding in BPH?

A
  1. reduced flow
  2. hesitancy
  3. incomplete emptying
  4. strangury
33
Q

What is storage in BPH?

A
  1. Frequency (daytime and nocturia)
  2. urgency
  3. incontinence
34
Q

What are the other symptoms in BPH?

A
  1. visible haematuria

2. infection

35
Q

What do you need to ask for in BPH?

A

fluid intake

36
Q

What happens in the examination of BPH?

A
  • General examination
  • Palpable bladder
  • Ballotable kidneys
  • Phimosis
  • Meatal stenosis
  • Enlarged prostate on DRE, size, consistency, nodules, anal tone and sensation
37
Q

What investigations need to be carried out in BPH?

A
  1. Urine dipstick
  2. Flow rate + PVR
  3. IPSS Questionnaire
  4. Bladder diary
  5. USS KUB if impaired renal function, loin pain, haemturia, renal mass on examination
  6. PSA, creatinine
  7. Flexible cystoscopy in some circumstances
  8. TRUS prostate
  9. Urodynamic studies
38
Q

What is the non-pharmacological treatment of BPH?

A
  • Watchful waiting

- Lifestyle changes

39
Q

What is the pharmacological treatment of BPH?

A
  • alpha-adrenergic antagonists
  • 5-alpha-reductase inhibitors
  • combination therapy
40
Q

What are alpha-adrenergic antagonists and what do they do?

A
  1. e.g. Tamsulosin, alfuzosin, doxazosin

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

41
Q

What are 5-alpha reductase inhibitors and what do they do?

A
  1. e.g. Finasteride, Dustasteride

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

42
Q

What are the surgery options for BPH?

A
  • TURP
  • Rezum
  • UroLIFT
  • Millin’s prostatectomy
  • Embolisation
  • HoLEP
43
Q

What is urinary incontinence (UI)?

A

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

44
Q

How common is UI in women?

A
  1. In women, prevalence 5-72% among community-dwelling women
  2. It may be significantly under-reported as it is an embarrassing problem to many women
  3. Women with SI are less likely to seek help than those with OAB
45
Q

What is UI?

A

The complaint of any involuntary loss of urine

46
Q

What are the different types of UI?

A
  1. Stress (urinary) incontinence
  2. Urge (urinary) incontinence
  3. Mixed urinary incontinence
  4. Continuous incontinence
  5. Overflow incontinence
  6. Nocturnal enuresis
  7. Post-micturition dribble
47
Q

What is stress (urinary) continence?

A

the complaint of involuntary leakage on exertion /sneezing/coughing

48
Q

What is urge (urinary) incontinence?

A

the complaint of an involuntary leakage accompanied by or immediately preceded by urgency

49
Q

What is mixed urinary incontinence?

A

the complaint of an involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing

50
Q

What is continuous incontinence?

A

continuous leakage

51
Q

What is overflow incontinence?

A

leakage associated with urinary retention

52
Q

What is nocturnal enuresis?

A

the complaint of loss of urine occurring during sleep

53
Q

What is post-micturition dribble?

A

the complain of an involuntary loss of urine immediately after passing urine

54
Q

What is the epidemiology of UI?

A
  1. Increasing age
  2. Pregnancy and vaginal delivery
  3. Obesity
  4. Constipation
  5. Drugs e.g. ACE inhibitors
  6. Smoking
  7. Family history
  8. Prolapse/hysterectomy/menopause
55
Q

What are the investigations of UI?

A
  • Urine dipstick
  • Flow rate and post-void residual
  • Bladder diary
  • Pad tests
  • Patient symptom scores/validated QoL questionnaire
  • Urodynamic/video-urodynamic studies
56
Q

When is SI common?

A

women of young to middle age

57
Q

When is SI uncommon?

A

who have not had prostate surgery

58
Q

What are the causative theories of SI in women?

A
  1. Urethral position theory
  2. Intrinsic sphincter deficiency
  3. Integral theory
  4. Hammock theory
  5. Trampoline theory
59
Q

What are the non-surgical treatments of SI?

A 
1. Lifestyle changes 
•weight loss
•cessation of smoking
•modification of high/low fluid intake
2. Supervised pelvic floor exercises
3. Bladder re-training
60
Q

What is the pharmacological treatments of SI?

A
  1. Oestrogen therapy if there is evidence of atrophy

2. Oral medical therapy in rare cases

61
Q

What are the surgical options for SI?

A
  1. Occlusive e.g. bulking, compressive (AUS)
  2. Supportive (mid-urethral sling, colposuspension) (men: suburtheral sling)
  3. Ileal conduit diversion
62
Q

What are the 3 causative theories of SI in men?

A
  1. Sphincter incompetence
  2. Reduction in urethral sphincter length
  3. Post-operative strictures
63
Q

What 5 structures control continence?

A
  1. Detrusor muscle
  2. Internal sphincter
  3. Ureterotrigonal muscles
  4. Levator muscles
  5. Rhabdosphincter (external sphincter muscle)
64
Q

What happens in OAB?

A
  • symptoms syndrome

- urinary frequency, urgency, nocturia with or without leaks

65
Q

What is the prevalence of OAB?

A
  1. 16% in men and women
  2. Men have a higher prevalence of AOB-dry
  3. Women have higher prevalence of AOB-wet
66
Q

What are the differential diagnosis of urge urinary incontinence (UUI)?

A
  • UTI
  • DO
  • Urethral syndrome
  • Urethral divertivulum
  • Interstitial cystitis
  • Bladder cancer
  • Large residual volume
67
Q

What is the management of UUI?

A 
1.Lifestyle changes 
•decreasing caffeine intake
•stopping smoking
•losing weight if obese
2. Bladder retaining 
3. Pelvic floor muscle exercises
68
Q

What is the pharmacotherapy of UUI?

A
  • Efficacy is 50-75%
  • Anti-cholinergics e.g. solifenacin, tolterodine, trospium
  • Beta-3-agonists e.g. betmiga
69
Q

What is the surgery available for UUI?

A
  1. Posterior tibial nerve stimulation (PTNS)
  2. Intravesical injection of botulinum toxin A
    •Efficacy is 36-89%, mean efficacy is 70%, upto a mean time of 6 months
  3. Neuromodulation
    •50% cure rate, 25% significant improvement of symptoms, 25% failure rate
  4. Clam (augmentation) cystoplasty
    •50% cure rate, 25% significant improvement of symptoms, 25% failure rate
  5. Urinary diversion is an option if all else fails in very severe cases
70
Q

What is Lower Urinary Tract Symptoms (Prostatism) in BPH?

A

non-specific term for symptoms which may be attributable to lower urinary tract dysfunction

71
Q

What is benign prostatic hyperplasia?

A

histological diagnosis

72
Q

What is bladder outflow obstruction?

A

urodynamically proven obstruction to passage of urine

73
Q

What is benign prostatic enlargement?

A

clinical finding of enlarged prostate

74
Q

What is benign prostatic obstruction?

A

= BOO caused by BPE

75
Q

What is benign prostatic hypertrophy?

A

pathologically incorrect

Z Year 2 BRS URO (5 decks)

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