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Y2 Urology & Renal Medicine > Urinary incontinence & BPH > Flashcards

Urinary incontinence & BPH Flashcards

(59 cards)

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1
Q

What is the normal diameter of a ureter?

A

3mm

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2
Q

What are the 3 sites of constriction in a ureter?

A

Pelvic-ureteric junction
Pelvic brim
Entrance to bladder

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3
Q

What are the three layers of the ureter? (sup to deep)

A

Outer fibrous tissue
Middle muscle layer
Inner epithelium layer

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4
Q

What is the blood supply to the ureters?

A

Related to the region
Renal/lumbar/gonadal/common iliac
Internal iliac
Superior vesical arteries

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5
Q

What is the lymphatic drainage of the ureters?

A

Left: left para-aortic nodes
Right: right paracaval & interaortocaval lymph nodes

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6
Q

What is the nerve supply of the ureters?

A

Autonomic nervous system

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7
Q

What are the 3 layers of the bladder? (sup to deep)

A

Outer loose connective tissue
Middle smooth muscle & elastic fibres
Inner transitional epithelium

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8
Q

What is the blood supply to the male bladder? (arterial and venous)

A

Arterial: superior & inferior vesical branches of internal iliac artery

Venous: prostatic plexus -> internal iliac vein

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9
Q

What is the blood supply to the female bladder?

A

Arterial: superior & inferior vesical branches of internal iliac artery

Venous: vesical plexus -> internal iliac vein

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10
Q

What is the lymphatic drainage of the bladder in the F GU system?

A

Internal iliac nodes -> para-aortic nodes

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11
Q

What is the nerve supply of the bladder in the F GU system?

A

ANS

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12
Q

Describe the two urethral sphincters in the F GU in terms of their control

A

Internal urethral sphincter - detrusor muscle, involuntary control
External urethral sphincter - skeletal muscle, voluntary control

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13
Q

How long is the female urethra?

A

3-4 cm

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14
Q

How long is the male urethra?

A

20 cm

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15
Q

What is the blood supply to the female urethra?

A

Internal pudendal arteries
Inferior vesical branches of vaginal arteries

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16
Q

What is the lymphatic drainage of the female urethra?

A

Proximal - internal iliac nodes
Distal - superficial inguinal nodes

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17
Q

What is the nerve supply to the female urethra?

A

Vesical nerve plexus and pudendal nerve

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18
Q

Where is the prostate gland found?

A

Underneath bladder
Surrounds prostatic urethra

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19
Q

What is the function of the prostate?

A

Secrete 75% of seminal fluid to liquify coagulated semen after deposition in the female genital tract

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20
Q

What are the 3 parts of the prostate?

A

Left lateral lobe
Right lateral lobe
Middle lobe

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21
Q

What is the blood supply to the prostate?

A

A: Inferior vesical artery

V: Prostatic plexus -> vesical plexus -> internal iliac vein

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22
Q

What is the lymphatic drainage of the prostate?

A

Internal iliac and sacral nodes

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23
Q

What is the nerve supply of the prostate?

A

ANS

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24
Q

What are the 3 parts of the male urethra?

Study These Flashcards
A

Prostatic
Membranous
Spongy

25
What is the blood supply to the male urethra?
Prostatic: inferior vesical artery Membranous: bulbourethral artery Spongy: internal pudendal artery
26
What is the nerve supply to the male urethra?
Prostatic plexus
27
What are the two phases of micturition?
Filling phase Voiding phase
28
Describe the filling phase of micturition
1. Bladder fills & distends without rise in intravesical pressure 2. Urethral sphincter contracts
29
Describe the voiding phase of micturition
1. Bladder contracts 2. Urethral sphincter relaxes
30
What receptors are stretched in the bladder as it fills? Where are they found? Which spinal nerves activate them? What neurotransmitter is used? Which branch of the ANS is involved?
M3 receptors On detrusor muscle S2-4 ACh Parasympathetic
31
What is the action of the parasympathetic fibres on the bladder
Activation of M3 receptors & contraction of the detrusor muscle Inhibition & relaxation of internal urethral sphincter
32
What receptors are activated after the voiding phase? Which spinal nerves are involved? What neurotransmitter is used? Which branch of the ANS is involved?
Beta-3 receptors T11-L2 Noradrenaline Sympathetic
33
What is the definition of stress urinary incontinence?
Involuntary urinary leakage on effort or exertion (e.g. sneezing, coughing)
34
What are the risk factors for stress urinary incontinence?
Age Obesity Smoking Pregnancy & route of delivery
35
What is the pathology behind stress urinary incontinence?
Impaired bladder and urethral support Impaired urethral closure Urethral hypermobility
36
What investigations should be done to diagnose stress urinary incontinence?
Positive stress test (demonstrate loss of urine when coughing etc) Urodynamics
37
What are urodynamics?
Catheterise patient Pressure line placed in rectum and bladder Cough/increase intra-abdo pressure See if detrusor muscle contracts as well
38
How can urodynamics be used to diagnose stress urinary incontinence?
Urinary leakage seen during increase in intra-abdo pressure with absence of detrusor contraction
39
What are the non-surgical and surgical management options for stress urinary incontinence?
Non-surgical: physio (pelvic floor exercises) Surgical: mid-urethral sling, colposuspension, periurethral bulking agents
40
What is urge urinary incontinence?
Urinary urgency, usually with increased frequency and nocturia, with or without incontinence
41
What are the risk factors for urge incontinence?
Age Prolapse Increased BMI IBS Bladder irritants (caffeine, nicotine)
42
What is the pathology behind urge incontinence?
Involuntary detrusor muscle contractions Causes: idiopathic, neurogenic or bladder outlet obstruction
43
What are the signs and symptoms of urge incontinence?
Increased urgency, frequency and nocturia Urgency incontinence Impact on QoL - sleep disorders, anxiety, depression Signs: Enlarged prostate Prolapse in women
44
What investigations can be done for urge incontinence?
Urine dip to exclude infection Voiding diaries to record volumes drank and urinated Ultrasound for post void residual volume Urodynamics Cystoscopy of bladder
45
What management can be done for urge incontinence?
Lifestyle (smoking, caffeine, alcohol) Physio (aim to pee every 3 hours) Antimuscarinic drugs Beta-3 agonists Botox into detrusor muscle Neuromodulation (stimulation of S3 or posterior tibial nerve) Surgical (urinary diversion into bowel, augmentation cystoplasty)
46
What is overflow incontinence?
Leakage of urine due to over-full bladder
47
What are some causes of overflow incontinence? (5)
Outlet obstruction (faecal impaction, BPH) Drugs (anticholinergics, sedatives, alpha adrenergics) Iatrogenic (bladder denervation post-surgery) Urethral/bladder neck stricture Underactive detrusor muscle
48
What is continuous incontinence? What are some causes?
Continuous loss of urine at all times Causes - vesicovaginal fistula, ectopic ureter
49
What is functional incontinence? What are some causes?
Bladder function normal Caused by severe cognitive impairment or mobility limitations e.g. dementia
50
What is benign prostatic hyperplasia? What are the risk factors?
Non-malignant hyperplasia of prostate tissue Risk factors: effects of testosterone on prostate
51
What is the pathology of BPH? How can it affect urination?
Hyperplasia of all 3 lobes of prostate gland Compression on urethra = bladder outflow obstruction
52
What are some signs & symptoms of BPH?
Hesitancy in starting urination Poor stream Dribbling post-micturition (incomplete emptying) Frequency, nocturia Acute retention
53
What investigations can be done in BPH? (6)
Urine dip Post void residual volume (ultrasound) Voiding diary Blood tests Urodynamics Cystoscopy
54
What blood test can be used to diagnose BPH?
PSA (prostate-specific antigen)
55
What lifestyle management options are there for BPH?
Weight loss Reduce caffeine & fluid intake in evening Avoid constipation
56
What medical management options are there for BPH?
Alpha-blocker 5-alpha reductase inhibitor (prevents conversion of testosterone into DHT)
57
How do alpha blockers work in BPH?
Alpha 1 adrenergic receptors are present on prostate stromal smooth muscle and bladder neck Blockage of receptors results in relaxation
58
How do 5-alpha reductase inhibitors work in BPH?
Prevents conversion of testosterone to DHT DHT promotes growth of prostate Results in shrinkage
59
What are some surgical management options for BPH?
Transurethral resection of prostate

Y2 Urology & Renal Medicine (3 decks)

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