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What is nocturnal enuresis characterized as?
What is nocturnal enuresis characterized as?
What is the primary symptom of stress urinary incontinence?
What is the primary symptom of stress urinary incontinence?
What is the anatomic mechanism of incontinence in stress urinary incontinence?
What is the anatomic mechanism of incontinence in stress urinary incontinence?
What is the definition of urgency in the context of urinary incontinence?
What is the definition of urgency in the context of urinary incontinence?
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What is the term for the combination of anatomic and intrinsic sphincteric deficiency mechanisms of incontinence?
What is the term for the combination of anatomic and intrinsic sphincteric deficiency mechanisms of incontinence?
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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?
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?
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What is the approximate length of the urethra?
What is the approximate length of the urethra?
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What is the function of the urethra?
What is the function of the urethra?
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What is the name of the muscle that relaxes during the voiding phase of the micturition cycle?
What is the name of the muscle that relaxes during the voiding phase of the micturition cycle?
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What is the pressure range of the detrusor muscle during the filling phase?
What is the pressure range of the detrusor muscle during the filling phase?
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What is the purpose of the pubourethral ligaments?
What is the purpose of the pubourethral ligaments?
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At what volume is the first mild desire to void commonly felt?
At what volume is the first mild desire to void commonly felt?
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What is the name of the muscle that contracts during the voiding phase of the micturition cycle?
What is the name of the muscle that contracts during the voiding phase of the micturition cycle?
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What is the name of the muscle that makes up the lower part of the extrinsic sphincter?
What is the name of the muscle that makes up the lower part of the extrinsic sphincter?
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What is the average rate of urine production in the kidney?
What is the average rate of urine production in the kidney?
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What is the main function of the ureter?
What is the main function of the ureter?
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What is the triangular area in the urinary bladder called?
What is the triangular area in the urinary bladder called?
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What is the composition of the serosa layer in the urinary bladder?
What is the composition of the serosa layer in the urinary bladder?
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What is the angle of the urethra with the base of the urinary bladder at rest?
What is the angle of the urethra with the base of the urinary bladder at rest?
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What is the direct branch of the aorta that supplies blood to the kidney?
What is the direct branch of the aorta that supplies blood to the kidney?
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What is the function of the muscular layer in the urinary bladder?
What is the function of the muscular layer in the urinary bladder?
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What is the structure that connects the kidney to the urinary bladder?
What is the structure that connects the kidney to the urinary bladder?
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What is a congenital factor that contributes to urinary incontinence?
What is a congenital factor that contributes to urinary incontinence?
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What is a common symptom of stress urinary incontinence?
What is a common symptom of stress urinary incontinence?
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What is the primary goal of bladder training in non-surgical treatment of urinary incontinence?
What is the primary goal of bladder training in non-surgical treatment of urinary incontinence?
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What is the purpose of the cough stress test in the assessment of urinary incontinence?
What is the purpose of the cough stress test in the assessment of urinary incontinence?
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What is the recommended duration for pelvic floor muscle training in non-surgical treatment of urinary incontinence?
What is the recommended duration for pelvic floor muscle training in non-surgical treatment of urinary incontinence?
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What is the recommended approach for managing mixed urinary incontinence?
What is the recommended approach for managing mixed urinary incontinence?
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What is a potential risk factor for urinary incontinence?
What is a potential risk factor for urinary incontinence?
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What is the recommended initial step in managing urinary incontinence?
What is the recommended initial step in managing urinary incontinence?
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What is the primary treatment of stress incontinence?
What is the primary treatment of stress incontinence?
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How many procedures have been described in the literature for the treatment of stress incontinence?
How many procedures have been described in the literature for the treatment of stress incontinence?
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What type of operation is typically performed for stress incontinence?
What type of operation is typically performed for stress incontinence?
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What is the purpose of bulking agents in the treatment of urinary incontinence?
What is the purpose of bulking agents in the treatment of urinary incontinence?
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What is the primary treatment of urgency incontinence?
What is the primary treatment of urgency incontinence?
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What is the type of operation that includes Kelly’s operation, Tension-free Vaginal tape (TVT), and Transobturator tape (TOT)?
What is the type of operation that includes Kelly’s operation, Tension-free Vaginal tape (TVT), and Transobturator tape (TOT)?
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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
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Description
This quiz covers the basics of urinary incontinence and the anatomy of the urinary tract, including the kidneys, ureters, bladder, and urethra.
