Urology Lecture

Question 1

Childs bladder capacity

Answer 1

(Age + 1) x 30 mls

Question 2

What are causes of neuropathic bladder?

Answer 2

• Spina bifida
• Bladder extrophy - bladder protrudes through defect in abdomen
• Cloacal malformation - common channel, single orifice only for vagina, bowel and bladder
• Spinal cord damage
• Brain/nerve damage

Question 3

Symptoms of neuropathic bladder

Answer 3

• UTIs
• Kidney stones
• Urinary incontinence
• Urinary frequency and urgency
• Small urine volume during voiding
• Dribbling urine

Question 4

Structural bladder problems

Answer 4

• Vesico-ureteric relfux - urine travels backwards to kidneys via ureters
• Ureterocele - distal ureter balloons at opening into bladder forming pouch
• Pelvi-ureteric junction obstruction - connection between renal pelvis and ureter becomes narrow
• Posterior urethral valves - narrowing due to extra membranes in urethra

Question 5

Cause of VUR

Answer 5

• Ureter usually enters bladder at angle through wall, forming a tunnel of muscle
• VUR ureter goes straight through wall of bladder = open entrance and reflux occurs
• Can also occur when bladder pressure gets too high if blockage below

Question 6

PUV diagnosis

Answer 6

• Often diagnosed via US antenatally

Question 7

Features of PUV

Answer 7

• Bilateral hydronephrosis
• Dilated prostatic urethra
• Distended bladder with thickened wall greater than 3mm

Question 9

Management of PUV

Answer 9

• Insert catheter to drain bladder
• Manage fluid imbalances
• Abx if infection
• Cystoscopy and valve ablation
• Monitor kidney function, kidney growth and bladder training through till adolescence

Question 10

Normal voiding amounts

Answer 10

4-8x per day

Question 11

Symptoms of OAB

Answer 11

• Daytime and nighttime wetting
• Urgency
• Frequency

Question 12

OAB causes

Answer 12

• Constipation
• Reduced drinking
• Caffeinated drinks
• Holding/delaying toileting
• UTI

Question 13

What is underactive bladder?

Answer 13

• Detrusor underactivity which is a bladder that has a contraction reduced in strength and/or duration
• = prolonged/slow bladder emptying or inability to empty in normal timeframe

Question 14

Symptoms of underactive bladder

Question 15

Nocturnal enuresis often related to…

Answer 15

• Slow physical development
• FH bedwetting
• Making too much urine at night

Question 16

Causes of nighttime wetting

Answer 16

• Small bladder - inability to hold large amount
• No awareness of full bladder
• Constipation
• Stress at school/home
• Poor daytime toilet habits

Question 17

Initial assessment in urology for children

Answer 17

• Bladder diary and stool diary - drink, wee and stool diary
• USS
• Detailed history inc potty training, UTI or bowel issues
• Physical exam - abdominal palpation for ?distension, faecal loading

Question 18

Intial management for urology problems

Answer 18

• Treat constipation
• Drink enough
• Accessing toilet every 2-3hrs
• Sitting and relax bladder
• Avoid withholding
• Family centred
• Intermittent self catherisation

Question 19

Medication for OAB

Answer 19

• Anticholingerics - oxybutynin, solifenacin, tolterodine
• Surgery - botox/steroids

Question 20

Investigations in urology

Answer 20

• Renal USS + x-ray
• Uroflowetry - urine released from body, speed of release and how long
• Urodynamics - how well bladder can hold and release urine, fill bladder and measure pressures
• Cystoscopy if needed

Question 21

Longer term management for bladder that is not emptying effectively

Answer 21

• Intermittent catheters
• Mitrofanoff - create channel from bladder to surface of skin using appendiz/small intestine - long term in place of indwelling catheter
• Suprapubic catheters