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And then we should be able to see as people join. Yeah, so we've got a few people joining now. Um And then I'll make a start at um 630. All right. Ok. Um Hello everyone. Thank you for joining us today. My name is Gabby and I am the educational um lead at a, this week. We are going to be focusing on um urology specifically today, retention and incontinence. Um And we're really excited to have you all with us today. I'm joined by Karen and Tim who are both um fifth year medical students at Plymouth University um to make the session as engaging as possible. We'll be releasing some polls throughout. Um These are completely anonymous. So we really encourage you to participate actively. Um If you have any questions during the session, please pop them in the chart and we'll do our best to address them at the end of the uh session. We'll share a feedback form. If you complete this, you'll receive a certificate of attendance and exclusive discount codes for teach me surgery and pass the MRC S Additionally, this session is being recorded, the recording and slides will be shared on our meal um page in a couple of hours after the session. So be sure to keep an eye on that. Um We're also excited to share that um exclusive question bank and other resources will be available on our learning portal. So be sure to check out our website to access them. If you create a free membership account with us, you'll automatically receive a discount code for 10% off. Um G Medics, anatomy flash cards, surgery, flashcards, and non knowledge bundle. Um We also have an exciting opportunity for all our attendees. Two lucky people will win free access to the GKI medics surgical flashcards and the GKI medics ay stations to enter simply complete the Google form at the end of the session and enter the unique code that we will provide the more sessions you attend the higher your chances of winning. So be sure to stay until the end of today's session. Um Finally, before we begin, we'd like to thank our partners, the Royal College of Surgeons of England, Gee medics, the MDU more than um skin deep metal, teach me surgery and pass the MRC S. So without further ado, I'd love to hand it over to uh Karen and Tim. Hi everyone. My name's Karen. I'm one of the final year med students at Peninsula. So I'm gonna start starting the session and we'll go straight into it. So, learning objectives include reviewing the anatomy of the bladder and the urethra in both males and females including the innovation er and compare and contrast. The anatomical differences between both, discuss how this relates to a difference uh in different types of urinary incontinence as well as different methods of treatment for these conditions. Discuss the internal and external anatomy of the prostate, including its relation to the bladder. Recall, the medical and surgical management of both BBH. So, um prosthetic hyper uh hypertrophy and prostate cancer as well. And look at the presentation of acute and chronic urinary retention. We'd also like you to understand the anatomy of the male and external genitalia, including the contents of the scrotum, as well as recognizing red flag symptoms of scrotal pain and swelling for surgical emergencies and be able to form a list of differentials including their clinical differences and moving on to the, the second half of the session. We're focusing more on understanding the embryological descent of the testes. Becoming familiar with the layers of the sp spermatic cord and the walls of the inguinal canal. And we're gonna appreciate the formation of hernias and the surgical management and eventually record what procedures post surgery. So the anatomy of the bladder, the bladder is an organ of the urinary system that stores and exposes urine. The bladder connects the ureter superiorly to the urethra inferiorly. So we sort of see here, got the uterus and we've got the urethra down here. Um, the ureters themselves, they actually enter the bladder at the orifice of orifices, which are superior aspect of the trigone, which is a sort of triangle shaped area here, as you can see on the diagram and the bladder is made up of a thick muscle layer called the Detrusa muscle, which contracts to push urine out of the urethra. But the Y detrusa musa itself receives both sympathetic and parasympathetic innovation. The trigone is like I said, this triangular shaped or funnel shaped area which helps retain the oblique direction of the ureters at the top and thus prevents reflux of urine back into the ureters. There are also two muscular sphincters located in the urethra, the internal and the external urethra sphincter. The internally ref sphincter in males particularly consists of a circular smooth fibers which are under autonomic control and this prevents seminal regurgitation during ejaculation as well. Whereas in females, this is a functional sphincter and doesn't act quite the same way. It doesn't in males. And the external urethral sphincter is a skeletal muscle and under your own voluntary control, essentially. So, when it comes to the anatomy of the bladder and, and it's actual nervous supply, um the bladder has autonomic and somatic nervous supply. This is in the form of sympathetic supply from the hypergastric nerves. So T 12 and L2, which allows for relaxation of the actual detrusor muscle as well as parasympathetic innervation from the pelvic nerves of S two and S four, which allows for contraction of the, the er detrusor muscle and somatic innervation from the pre uh predental nerve, which is S two and S four. And this innervates the external refill sphincter and thus provides voluntary control over micturition. There are also some sensory or sometimes they're called afferent nerves found in the bladder wall which also reports bladder fullness and mechanical stretch uh to the C NS. So, basically telling you when you need to go to the toilet, when it comes to the vasculature of the bladder. Uh it's primarily derived from the internal iliac vessels which divide into the superior vesical branch of the internal iliac artery. In males, this is supplemented by the inferior vesical artery and in females by the vaginal arteries as well. And in both sexes, the obturator and inferior gluteal arteries sometimes contribute smaller branches but not always. And venous drainage is primarily provided by the Vesa called venous plexus. And this empties into the internal iliac veins which move back onto the IVC.