36 Questions
What is nocturnal enuresis characterized as?
Involuntary loss of urine during sleep
What is the primary symptom of stress urinary incontinence?
Involuntary loss of urine on effort or physical exertion
What is the anatomic mechanism of incontinence in stress urinary incontinence?
Weak pelvic floor support
What is the definition of urgency in the context of urinary incontinence?
A sudden, compelling desire to pass urine which is difficult to defer
What is the term for the combination of anatomic and intrinsic sphincteric deficiency mechanisms of incontinence?
Mixed incontinence
What is the term for the sign of stress urinary incontinence, characterized by an involuntary droplet of urine leaving the urethra immediately on an increase in intra-abdominal pressure?
Sign
What is the approximate length of the urethra?
3-4 cm
What is the function of the urethra?
To transport urine from the bladder to outside the body
What is the name of the muscle that relaxes during the voiding phase of the micturition cycle?
Urethral sphincter muscle
What is the pressure range of the detrusor muscle during the filling phase?
less than 15 cm H2O
What is the purpose of the pubourethral ligaments?
To support the urethra
At what volume is the first mild desire to void commonly felt?
150-200 mL
What is the name of the muscle that contracts during the voiding phase of the micturition cycle?
Detrusor muscle
What is the name of the muscle that makes up the lower part of the extrinsic sphincter?
Compressor urethrae
What is the average rate of urine production in the kidney?
1 ml / minute
What is the main function of the ureter?
Transportation of urine from the kidney to the urinary bladder
What is the triangular area in the urinary bladder called?
Trigone
What is the composition of the serosa layer in the urinary bladder?
Connective tissue composed of collagen and elastic fibers
What is the angle of the urethra with the base of the urinary bladder at rest?
90-100°
What is the direct branch of the aorta that supplies blood to the kidney?
Renal artery
What is the function of the muscular layer in the urinary bladder?
Contraction to facilitate urination
What is the structure that connects the kidney to the urinary bladder?
Ureter
What is a congenital factor that contributes to urinary incontinence?
Connective tissue disorder
What is a common symptom of stress urinary incontinence?
Escape of small amounts of urine immediately following cough
What is the primary goal of bladder training in non-surgical treatment of urinary incontinence?
Improve bladder muscle tone
What is the purpose of the cough stress test in the assessment of urinary incontinence?
To observe urine leakage with stress
What is the recommended duration for pelvic floor muscle training in non-surgical treatment of urinary incontinence?
At least 3 months
What is the recommended approach for managing mixed urinary incontinence?
Treatment according to the dominant component
What is a potential risk factor for urinary incontinence?
Chronic constipation
What is the recommended initial step in managing urinary incontinence?
Non-surgical management
What is the primary treatment of stress incontinence?
Surgical treatment
How many procedures have been described in the literature for the treatment of stress incontinence?
More than 200
What type of operation is typically performed for stress incontinence?
Either vaginally, abdominally, or abdomino-vaginally
What is the purpose of bulking agents in the treatment of urinary incontinence?
To inject permanent materials to achieve effectiveness
What is the primary treatment of urgency incontinence?
Medical treatment
What is the type of operation that includes Kelly’s operation, Tension-free Vaginal tape (TVT), and Transobturator tape (TOT)?
Vaginal operations
Study Notes
The Urinary Tract
- The urinary tract consists of the kidney, ureter, urinary bladder, and urethra
- The kidney filters waste and excess fluids from the blood to produce urine
- Two kidneys, one on each side of the spine, filter about 1 liter of blood per minute
The Kidney
- Two kidneys, one on each side of the spine
- Shape: typical kidney shape
- Blood supply:
- Arterial: renal artery (direct branch from the aorta)
- Venous: renal vein to the inferior vena cava
- Parts:
- Fibrous capsule
- Cortex
- Medulla
- Collecting ducts (major and minor calyces)
- Pelvis
- Function: production of urine (average = 1ml / minute)
The Ureter
- Two ureters, one on each side of the spine
- Structure: hollow muscular canal
- Length = 25 cm
- Start: pelvis of the kidney
- End: urinary bladder
- Parts:
- Abdominal
- Pelvic
- Function: transportation of urine from the kidney to the urinary bladder
The Urinary Bladder
- A midline hollow sac that lies directly behind the pubic symphysis
- Layers:
- Mucosa (inner): transitional epithelium
- Musculosa: detrusor muscle (3 layers: outer & inner longitudinal / middle circular)
- Serosa (outer): connective tissue composed of collagen and elastic fibers
- Parts:
- Dome: upper part of bladder
- Trigone: triangular area with apex pointing downward at the urethral opening
- Relations:
- Posterior part of the superior surface: related to the uterus
- Posterior surface: related to the cervix and vagina
- Function: storage of urine
The Urethra
- A fibromuscular tube of approximately 3–4 cm in length
- Embedded in the anterior wall of the vagina and lies behind the symphysis pubis
- Two openings:
- Internal meatus: opens at the urinary bladder
- External meatus: opens at the vaginal vestibule
- Function: transport of urine from the bladder to outside the body
Urinary Incontinence
- Involuntary loss of urine
- Types:
- Stress urinary incontinence
- Urgency urinary incontinence
- Mixed incontinence
- Factors contributing to incontinence:
- Weak pelvic floor support
- Intrinsic sphincteric deficiency
- Congenital or acquired disorders
- Pregnancy and childbirth
- Obesity
- Increased intra-abdominal pressure
- Chronic cough or constipation
- Heavy lifting or mass
Assessment and Management
- Detailed history and physical examination
- Investigations:
- Urine analysis
- Voiding diaries
- Pad test
- Urodynamics
- Non-surgical management:
- Lifestyle interventions
- Physical therapies (pelvic floor muscle training, electrical stimulation)
- Behavioral therapies (bladder training)
- Surgical treatment:
- Vaginal operations (Kelly’s operation, TVT, TOT)
- Abdominal operations (MMK, Burch colposuspension)
- Abdomino-vaginal operations (pubo-vaginal sling)
- Medical treatment:
- Anticholinergic
- Selective beta agonist
- Antispasmodics
- Tricyclic antidepressant
- Hormonal treatment
- Duloxitene (antidepressant) for SUI
This quiz covers the basics of urinary incontinence and the anatomy of the urinary tract, including the kidneys, ureters, bladder, and urethra.
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