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Renal 8.04

prostate and bladder

Function of pontine micturition centre Recieves afferents from bladder stretch receptors and sends efferents to detrusor motor nucleus to initiate micturition reflex; It also recieves inputs from cortex and co-ordinates micturition
Bladder afferents PNS: desire to void and pain and temp SNS: sensation of fullness and pain and temp
Bladder efferents PNS (S2-4): detrusor motor nucleus SNS (T10-L2): bladder neck (alpha 1); detrusor relaxation (beta 3)
control of smooth mm sphincter (bladder neck/internal sphincter) alpha 1 (T10-L2)
control of striated mm sphincter somatic (S2-4)
Sacral centre of micturition consists of? Detrusor Motor Nucleus (PNS S2-4 involuntary) Pudendal Nucleus (Somatic S2-4 voluntary)
Pontine micturition centre responsible for? Co-ordinated micturition
Sacral centre (detrusor MN) responsible for? Co-ordinated bladder contraction
Sacral centre (pudendal nucleus) responsible for? Control of ext urethral sphincter
Storage symptoms? Frequency Urgency Urge incontinence Nocturia Dysuria
Voiding symptoms? Hesitancy Intermittemcy Slow flow Terminal dribbling Incomplete emptying
Does detrusor overactivity give you motor urgency or sensory urgency Motor (painless) as opposed to sensory which is painful (inflammatory or infectious)
2 types of detrusor overactivity Non-neurogenic (idiopathic) common Neurogenic (dementia; stroke; SCI etc)
Name 2 anticholinergics used to treat detrusor overactivity Oxybutynin Solifenacin (uroselective antimuscarinic) - less S/E's
2 types of female stress incontinence Urethral mobility (type 2) - high leak pressures Intrinsic sphincter deficiency (type 3) - low leak pressures
3 types of neuropathic bladder lesions Suprapontine Infrapontine (suprasacral) Infrasacral
Suprapontine lesion results in? detrusor hyperreflexia normal voiding normal sensation
Suprasacral (infrapontine) lesion results in detrusor hyperreflexia DSD (detrusor and sphincter dyssynergia) Loss of sensation
Infrasacral lesion results in? acontractile detrusor isolated sphincter obstruction +/- loss of rhabdosphincter loss of sensation
Zone of prostate most affected by cancer zone 1 - peripheral zone
Zone of prostae most affected by BPH zone 3 - middle zone
Testosterone is coverted to dihydrotestosterone DHT by? 5-α-reductase
prevelance of BPH 14% (40-50 yo) 43% (>60 yo) Note: microscopically, changes start at 35 and 50% prevelance at age 60 (100% at age 80) but macroscopically 8% by 45 yo and 53% by 85 yo
Mechanism of action of Finasteride Inhibits conversion of testosterone into 5-alpha-dihydrotestosterone, a potent androgen (by inhibiting 5-alpha-reductase)
Treatment options for BPH Watchful waiting Drug therapy Minimally invasive therapies Cavitating technologies
Drug therapy for BPH Alpha blockers: Prazosin; terazosin; tamsulosin 5-alpha-reductase inhibitors: Finasteride (shrinks prostate by 20% and halves PSA levels)
Arterial supply of penis? External iliac branches to internal pudendal artery and has deep artery and dorsal artery on each side
Venous drainage of penis? mostly drained by deep dorsal vein (passes inferior to pubic symphysis); also is a superficail dorsal vein: note these are midline (arteries have one on each side)
Where do veins of penis drain to? prostatic venous plexus
Relaxation of smooth muscle of corpora results in? Erection
Contraction of corporal smooth muscle results in? Detumescence
Nerve supply of penis PNS S2-4: relaxation of corporal smooth mm SNS T10-12:contraction of corporal smooth mm Somatic pudendal: sensory (dorsal nerve of penis) & motor (ischocavernosus and bulbocavernosus mm's)
Neurotransmitters that cause erection and detumescence Erection: NO Detumescence: NA and endothelin
Mechanism of action of Sidenafil Inhibits the action of phosphodiesterase 5 (PDE 5) ie increases cGMP ie potentiates the effect of NO
Risk factors for ED CV disease; DM; smoking; HT; poor general health; psychological and psychiatric disturbance
Classification of erectile dysfunction Vasculogenic: failure to fill or store Neurogenic: failure to initiate Endocrine: low testosterone; DM; prolactin excess Drugs: BBlocker; antidepressants etc
Prevelance of prostate cancer relative to other cancers 3rd behind breast Ca and melanoma
False causes of increased PSA Infection Ejaculation Trauma
Staging of prostate Ca T 1-4 (T3 is extracapsular) N1 (regional nodes involved) M1a-c (distal nodes; bone mets etc)
prevelance of microhaematuria 0.2-16% (higher in smokers) 5-20% will have significant disease
common causes of haematuria IgA nephropathy; thin BM disease; trauma; UTI; calculi; neoplasia; BPH; urethral conditions
Top 3 causes of glomerular haematuria IgA nephropathy 30% Mesangioproliferative GN 14% Focal segmental GN 13%
Stones that show up on CT but not on x-ray? Uric acid
Most common type of bladder cancer TCC: Transitional cell carcinomas
Prevelance of urolithiasis incidence: 0.2% (US) prevelance: 7% males; 3% females (women have higher levels of urinary citrate)
Recurrance rate of stones 10% at 1 year 35% at 5 yeaers 50% at 10 years
Most common types of stones? Calcium oxalate (60-70%) calcium phosphate (10-20%) mixed of above 2 (15-30%) struvate (6-20%) uric acid (5-15%)
Genetics of stones? Idopathic hypercalcuria AD trait Cystinuria AR chrom 2 RTA is also associated with stones Note: 25% of people with stones have a family hx of stones
Environmental factors causing stones? High protein/salt diet High purine diets Vit B6 deficiency (increased oxalate) dehydration Calium supplements and drugs increasing Ca
Created by: medcard



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