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3rd Year - Reproductive Diseases > 11. Female Urinary Incontinence > Flashcards

11. Female Urinary Incontinence Flashcards

1
Q

What nerves supply the Bladder?

A
  1. T10-L2 - Hypogastric Nerve (Sympathetic) - Storage
  2. S2-4 - (Parasympathetic)
  3. S2-4 - Pudendal Nerve (Somatic) - Voiding
    Note - Sympathetic = Storage / Parasymapthetic = Power
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2
Q

What is the definition of Urinary Incontinence?

A

Any involuntary Leakage of Urine

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3
Q

What is the definition of Stress Urinary Incontinence?

A

Involuntary Leakage on Effort or Exertion (Sneezing / Coughing)

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4
Q

What is the definition of Urge Urinary Incontinence?

A

Involuntary Leakage accompanied by (or immediately preceded by) Urgency

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5
Q

What is the definition of Mixed Urinary Incontinence?

A

Involuntary Leakage accompanied by (or immediately preceded by) Urgency AND on Effort or Exertion (Sneezing / Coughing)

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6
Q

What percentage of Women report Urinary Incontinence?

A
  1. 10-25% between 15-60
  2. 15-40% > 60
  3. > 50% in nursing homes
    Note - Prevalence increases with Age
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7
Q

What are the Risk Factors for Urinary Incontinence?

A
  1. Age/ Menopause
  2. Parity - Main Risk For Stress Incontinence
  3. Smoking / Medical Problems
  4. Increase in Intra-Abdominal Pressure
  5. Pelvic Floor Trauma
  6. Connective Tissue Disease
  7. Denervation / Surgery
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8
Q

What factors are Covered in a Urinary Incontinence History?

A
  1. Risk Factors
  2. Irritation / Incontinence Symptoms
  3. Voiding Symptoms
  4. Effect on QoL
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9
Q

What factors are Covered in a Urinary Incontinence Examination?

A
  1. General
  2. Abdominal - Mass (Space Occupying Lesion)
  3. Gynaecological - Uro-Genital Atrophy
  4. Pelvic Floor Assessment - Prolapse
  5. Neurological
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10
Q

What factors are Covered in a Urinary Incontinence Investigation?

A
  1. 3 Days Urinary Diary
  2. Urinalysis - Multistix +/- MSSU
  3. Post-Voiding Residual Volume Assessment
  4. Urodynamics - Uroflowmetry
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11
Q

How is Stress Urinary Incontinence Managed?

A
  1. Lifestyle Changes
  2. Medical Treatments
  3. Physiotherapy
  4. Surgery
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12
Q

When does Stress Urinary Incontinence occur?

A

When Intra-Abdominal Pressure Exceeds Urethral Pressure, resulting in Leakage

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13
Q

In relation to Stress Urinary Incontinence, how is Urethral Closure Pressure Increased?

A
  1. Pelvic Floor Muscle Training
  2. Surgery
  3. Pharmacodynamic Agents
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14
Q

What Lifestyle Changes helps in the Management of Stress Urinary Incontinence?

A
  1. Stopping Smoking
  2. Losing Weight
  3. Eat more Healthily to Avoid Constipation
  4. Stop Drinking Alcohol and Cafeine
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15
Q

How does Pelvic Floor Muscle Training (Physiotherapy) help in Stress Urinary Incontinence?

A
  1. Reinforced of Cortical Awareness of Muscle Groups
  2. Hypertrophy of Existing Muscle Fibres
  3. General Increase in Muscle Tone / Strength
    Note - This is more effective than Electrical Stimulation and Vaginal Cones
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16
Q

What is the Pharmacological Treatment of Stress Urinary Incontinence?

A

Duloxetine - If PFMT does not work / surgery unfeasible

17
Q

Where do both Stress and Urge Urinary Incontinence arise from?

A

The Same Anatomical Defect in the Anterior Vaginal Wall and Pubo-Urethral Ligament

18
Q

What is the Surgical Management of Stress Urinary Incontinence?

A
  1. Retro-Pubic Tension-Free Vaginal Tape (TVT) - reinforce structures supporting the Urethra
  2. Colposuspension - Bladder gets Elevated to reduce pressure
19
Q

What are the Safety Concerns with Retro-Pubic Tension-Free Vaginal Tape (TVT)?

A
  1. Bladder Perforation
  2. Vaginal / Urethral Erosions
  3. Vascular Injury
20
Q

What is the Definition of Overactive Bladder Syndrome?

A

A Symptom Complex usually, but not Always, Related to Urodynamically Demonstrable Detrusor Overactivity / Urethrovesicle Dysfunction

21
Q

What are the Defining Symptoms of Overactive Bladder Syndrome?

A
  1. Urgency +/- Urge Urinary Incontinence

2. Frequent Nocturia

22
Q

What is the Definition of Urgency?

A

The complaint of a Sudden, Compelling Desire to pass Urine, that is difficult to Defer

23
Q

What is the Definition of Urge Incontinence?

A

The complain of Involuntary Leakage of Urine, accompanied by (or immediately preceded by) Urgency

24
Q

What is the Definition of Frequency?

A

The compliant by the patient who considers that he/she voids too often by day.
Note - Usually accompanies Urgency (+/- Urge Incontinence)

25
Q

What is the Definition of Nocturia?

A

The compliant that the individual has to wake at night 1+ times to void
Note - Usually accompanies Urgency (+/- Urge Incontinence)

26
Q

What are the Risk Factors for Urge Incontinence?

A
  1. Advanced Age
  2. Diabetes
  3. Urinary Tract Infections
  4. Smoking
27
Q

What is the Management of Overactive Bladder Syndrome?

A
  1. Treat Symptoms
  2. Lifestyle interventions
  3. Bladder Training Programme
  4. Pharmacological
    Note - There is no immediate Cure
28
Q

What are the Lifestyle Interventions, used to treat Overactive Bladder Syndrome?

A
  1. Normalise Fluid Intake
  2. Reduce Caffiene / Fizzy Drinks / Chocolate
  3. Stop Smoking
  4. Weight Loss
29
Q

What is the Bladder Training Programme?

Note - This is used to treat Overactive Bladder Syndrome

A

Timed Voiding with Gradually Increasing Intervals

30
Q

What are the Pharmacological Treatments of Overactive Bladder Syndrome?

A
  1. Antimuscarinic - Oral (Solifenacin / Fesoteridine / Trospium Chloride) vs Transdermal (Kentra Patches)
  2. Tricyclic Antidepressants - Imipramine
31
Q

What are the Recent Advances in treating Overactive Bladder Syndrome?

A
  1. Botulinum Toxin (Botox)

2. Neuromodulation - Needly Stimulation causing Reflex Inhibition to the Detrusor Muscle

3rd Year - Reproductive Diseases (41 decks)

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