1.9 Urine leaks, urodynamics Flashcards

1
Q

Urine leaks, urodynamics definition?

A

Incontinence is an involuntary leakage of urine through the urethra

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2
Q

types of incontinence?

A

Stress incontinence
Urge incontinence
Mixed incontinence
Overflow incontinence
Overactive bladder syndrome

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3
Q

what is stress incontinence?>

A
  • It is Mechanical problem
  • related to weak Pelvic floor muscles or sphincter
  • Upon coughing, laughing, physical activity –> increased
    intraabdominal pressure –> push on the bladder –> leakage.
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4
Q

stress incontenece risk factors?

A
  • Age
  • multiple childbirths
  • COPD
  • diabetes
  • gender: Female are more often affected
    Male are more affected if they have undergone a radical prostatectomy.
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5
Q

what is Urge incontinence?

A
  • detrusor m overactivity - Sudden contraction of the bladder
  • the patient will feel urge

seen in UTI and overactive bladder

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6
Q

Urge incontinence risk factors?

A
  • Age
  • obesity
  • disability
  • gender: Male will experience more urge incontinence
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7
Q

what is overflow incontinence?

A

Bladder outlet obstruction –> cannot void, bladder will become too full –> sudden overflow.

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8
Q

what is Overactive bladder syndrome?

A

related to Frequency, urgency with or without incontinence

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9
Q

diagnosis of urine leaks and urodynamics?

A
  • history of Voiding and bladder diaries
    (for 3 days write down all fluid intake and outlet with accurate time)
  • Urine examination; to exclude UTIs and bladder cancer (if hematuria is found)
  • Vaginal and rectal examination; look for prolapse
  • Uroflowmetry
  • Residual volume;(normal PVR volume of <50 mL, 50-100 in elderly)
    if >150-250ml –> need intervention
  • Ultrasound: for overflow incontinence
  • Urodynamical measurement( pelvic floor EMG, uroflowmetry, cystometry, pressure flow studies, urethral pressure profile)
  • Endoscopy
  • Radiology
  • Neurological exam
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10
Q

Urodynamics definition?

A

is a study that assesses how the bladder and urethra are
performing their job of storing and releasing urine

( pelvic floor EMG, uroflowmetry, cystometry, pressure flow studies, urethral pressure profile)

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11
Q

what is post-void resifual volume?

A
  • insertion of a urinary catheter/transducer following complete bladder emptying by the patient
  • The urine volume is measured (this
    shows how efficiently the bladder empties)
  • High volumes (180 ml) may be associated with UTIs.
  • High levels can be associated with overflow incontinence
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12
Q

what is Uroflowmetry?

A
  • Free uroflowmetry measures how fast the patient can empty his/her bladder
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13
Q

what is Pressure uroflowmetry?

A
  • measures the rate of voiding, but with simultaneous assessment of bladder and rectal pressures.
  • It helps demonstrate the reasons for
    difficulty in voiding. for example bladder muscle weakness or obstruction of the bladder outflow.
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14
Q

what is Multichannel cystometry?

A

Measures the pressure in the rectum and in the bladder, using two pressure catheters, to deduce the presence of contractions of the bladder wall, during bladder filling, or during other provocative maneuvers.

The strength of the urethra can also be tested during this phase, using a cough or Valsalva maneuver, to confirm genuine stress incontinence.

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15
Q

what is Urethral pressure profilometry?

A

Measures strength of sphincter contraction.

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16
Q

what is EMG?

A
  • Electromyography
  • measurement of electrical activity in the bladder neck
  • Assessing the “tightness” along the length of the urethra.
17
Q

what is Pressure flow study?

A

Detrusor function. Most sensitive method to diagnose bladder outlet obstruction.

18
Q

what are the normal results in pressure flow study?

A

High flow, low pressure

19
Q

what results show OBSTRUCTION in pressure flow study?

A

Low flow, high pressure

20
Q

what results show detrusor weakness in pressure flow study?

A

Low flow, low pressure

21
Q

what results show high-flow obstruction in pressure flow study?

A

High flow, high pressure

22
Q

what is the treatment of urinary leakage/incontinence in general?

A
  • Check normal fluid intake
  • Toilet training
  • Bladder training; upon the feeling of urge, wait before voiding to increase bladder capacity
  • Pelvic floor exercise, Kegel exercise
23
Q

what is the treatment of urge incontinence?
oral therapy

A

o Antimuscarinics
1. Oxybutynin: 90% will stop (due to SEs: Xerostomia, constipation, headache etc.)
2. Tolterodine
3. Solifenacin

o B3 agonist: – better tolerated. (SE: Increased blood pressure, palpitation)
1. Mirabegron

24
Q

alternative therapy of urge incontinence?

A
  • Botulinum intravesical injection
    (Need to be repeated)
  • SNM (sacral neuromodulation)
  • Tibialis posterior stimulation
  • Bladder augmentation
    (increase the size of the bladder with bowel seg)
25
Q

treatment of stress incontinence?

A
  • Off-label Duloxetine (SNRI).
    (Severe SEs. Do not prescribe this!)
    o No other pharmacological options today
  • Exercise, pelvic floor Kegel exercise.
  • TVT (tension free vaginal tape) for women. Make artificial obstruction
  • artificial urethral sphincter : AMS 800 for men