1. Bladder and urinary disorders

Question 1

Types of urinary incontinence

Answer 1

1. Urge incontinence - Resulting from issues with the destrusor bladder muscles
2. Stress incontinence - pelvic floor muscles that support the bladder become weak, urine may leak after coughing or sneezing common after childbirth

Question 2

Urge incontinence treatment

Answer 2

1st line: Antimuscarinic drugs (oxybutynin, tolterodine, solifenacin, darifenacin)

2nd line: Mirabegron
The drug allows the bladder muscles to relax.
Used in caution with QT interval prolongation,
CONTRAINDICATED: severe uncontrolled hypertension as it causes hypertension as a side effect

A side effect of antimuscarinics is being unable to pee

Question 3

Stress incontience treatment

Answer 3

1st line: Pelvic floor muscle training
2nd line: SNRI duloxetine may be used in moderate- severe stress incontinence.

Cannot be stopped suddenly,as it can cause withdrawal symptoms such as nausea, vomtiing, anxiety, headaches,

Question 4

Nocturnal enuresis

Answer 4

Bed-wetting, common in young children but may still persist in some

Question 5

Nocturnal Enuresis treatment

Answer 5

1st line: Enuresis alarms - alarms are triggered as soon as the child starts wetting the bed, to prevent the child passing urine. Should be continued until there are 2 weeks of uninterrupted dry nights

2nd line: desmopressin, (vasopressin analogue so prevents urine production) can be given sublingual or oral. NOT intranasally for nocturnal enuresis due to increased side effects.

Question 6

Desmopressin side effects and counselling

Answer 6

Side effects
* Hyponatraemia, resulting from too much water diluting the blood. Can lead to convulsions

Counselling
* Avoid fluid overload (e.g during swimming) and restrict fluid intake 1 hr before and 8 hours after desmopressin
* Desmopressin should be stopped in vomiting/diarrhoea

Question 7

Desmopressin interactions

Answer 7

Avoid drugs that increase vasopression secretion, such as tricylic anti-depressants

Question 8

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Benign Prostatic hyperplasia

Answer 8

Enlarged prostate that applies pressure to bladder wall, making urinaiton difficult

symptoms:
* Difficulty peeing
* Passing a small volume of urine
* Frequent urge to pee
* Weak urination flow

Question 9

Benign Prostatic hyperplasia treatment side effect, contraindications

Answer 9

1st line: Alpha blockers
Relax the smooth muscle of the prostate gland to improve urinary flow

ALternatively: Finasteride (5-alpha reductase inhibitors)

Question 10

Alpha blockers side effect and contrandications

Answer 10

Side effect: Hypertension, Postural hypotension (dizziness, blurred vision, tachycardia, palpitations)

CONTRAINDICATED: Postural hypotension

Question 11

Examples of alpha-blockers

Answer 11

• Terazosin
• Doxazosin
• Alfuzosin
• Tamsulosin

Question 12

Alpha blockers counselling

Answer 12

Take the first dose at bedtime.
Driving can be impaired as a result of dizziness

Question 13

5-alpha reductase inhibitors mechanism of action and examples

Answer 13

Prevent the conversion of testosterone into dihyrdotestosterone (more potent)

examples:
- Finasteride
- Dutasteride

Question 14

5-alpha reductase inhibitors side effects and counselling

Answer 14

Side effects:
* male breast cancer - report signs of lumps, pain or nipple discharge
* depression/suidical thoughts! - patients must report signs of depression and suicidal thoughts

Counselling

Finasteride excreted in sement so patients must use condoms if partner is pregnant or likely to get pregnant

Women of child-bearing potential must avoid handling crushed finasteride tablets and dutasteride capsules

Question 15

What is urlogical pain

Answer 15

Pain in the pelvic region or genitalia

Question 16

Urological pain treatment

Answer 16

• Topical applications such as lidocaine

Question 17

Acute urinary retention management

Answer 17

• Catheter inserted into the bladder
• Catheter inserted into the tummy (supra-pubic catheter)