19. Urogynaecology Flashcards
Types of urinary incontinence:
- Genuine stress incontinence (GSI)
- Urge incontinence
- Overflow incontinence
- True incontinence
Genuine stress incontinence:
Involuntary loss of urine when intravesical pressure exceeds maximum urethral closure pressure in absence of detrusor activity
Urge incontinence:
Involuntary loss of urine associated with a strong sensation to void
Outflow incontinence:
Failure of the bladder to empty due to bladder outlet obstruction or acontractile state
True incontinence:
Leakage of urine is happening continuously, without awareness of need to urinate.
Medical treatment for stress incontinence:
- Duloxetine (SNRI) 2nd line after Pelvic Floor Exercise and declined surgery
- Urethral bulking agents
- Artificial urinary sphincters
Duloxetine treatment for stress incontinence:
Increases intra urethral pressure by increasing tone in urethral smooth muscle
SE: difficulty sleeping, headaches, dizziness, N&V, sweating, tiredness
Urethral bulking agents:
- Non-immunogenic, biocompatible to reduce inflammation
- Large enough to prevent migration away from the injection site, durable
- Less effective than surgery
- Under cystoscopy – SM injection, proximal urethral, bulks the urethra and makes closure more effective
- Useful in elderly and frail
Artificial urinary sphincters:
- Hand-controlled pump and inflatable cuff
- When surgery has failed
- SE: infection, erosion, pain
Bladder retraining:
Suppress uninhibited detrusor contraction by gradually extending the time interval between the voids – using distraction therapies once the urge comes and gradually postponing the response
Medical treatment for overactive bladder:
- Anticholinergics - M3 receptor blockers
- Mirabegron – Beta 3 receptor agonists
- Intravaginal oestrogens – if vaginal
- Desmopressin – to reduce nocturia
Anticholinergics in overactive bladder:
- Immediate release oxybutynin (SE: dry eyes and mouth, constipation, urine retention)
- Selective M3 inhibitors: less SE but expensive
- Transdermal patches and extended release – improve compliance and reduce SEs.
Invasive/Surgical treatment for overactive bladder:
- Botulinum toxin A
- Percutaneous sacral or posterior tibial nerve stimulation
- Ileocystoplasty using ileal pouch
- Urinary diversion with ileal conduit
Lower UTI causative agents:
- E. Coli (70-95%)
- Staphylococcus saprophyticus (5-10%)
- Enterobacteriaceae: proteus mirabilis, klebsiella
Complications of UTIs:
- Acute pyelonephritis
- Impaired renal function
- Renal failure
- Sepsis
- Preterm labour
