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Urology > 2: Female Incontinence > Flashcards

2: Female Incontinence Flashcards

1
Q

Define incontinence

A

Involuntary leakage of urine

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2
Q

What are the 5 types of incontinence

A
  • Functional
  • Urge
  • Stress
  • Mixed
  • Continuous
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3
Q

What is functional incontinence

A

Normal urinary system - however individual cannot make toilet in time

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4
Q

What is stress incontinence

A

Leakage from incompetence sphincter on increase in intra-abdominal pressure

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5
Q

What is urge incontinence

A

Sudden desire to urinate following by involuntary leakage of urine

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6
Q

What is continuous incontinence

A

Continual urinary leakage.

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7
Q

How does prevalence of incontinence change with age

A

Increases

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8
Q

What are the two causes of stress incontinence

A
  • Increase intra-abdominal pressure

- Weak pelvic floor, urethral hypermobility

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9
Q

What can increase intra-abdominal pressure

A
  • Pregnancy

- Obesity

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10
Q

What can cause pelvic floor weakness and urethral hyper mobility

A
  • Childbirth
  • Ageing
  • Oestrogen withdrawal
  • Previous pelvic surgery
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11
Q

What are the causes of urge incontinence

A

Higher cortical dysfunction:

  • Stroke
  • PD
  • Dementia

Peripheral Neuropathy:
- Diabetes

Other:

  • UTI
  • Diuretics
  • Atrophic vaginitis
  • Urethritis
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12
Q

What is mixed incontinence

A

Stress and urge incontinence

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13
Q

What causes continuous incontinence

A

Vesicovaginal fistula

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14
Q

What are causes of functional incontinence

A
  • Dementia

- Immobility

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15
Q

How does urge incontinence

A

Strong desire to urinate followed by urination

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16
Q

How does stress incontinence present

A

Leakage small amounts of urine on increase IAP

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17
Q

How does mixed incontinence present

A

Stress and urge

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18
Q

How does continous incontinence present

A

Continuous leakage urine at all times

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19
Q

What two muscles help maintain continence

A
  • Internal sphincter

- External sphincter

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20
Q

What type of muscle is internal sphincter

A

smooth muscle

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21
Q

What type of muscle is external sphincter

A

skeletal muscle

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22
Q

Describe control of internal sphincter

A
  • Involuntary
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23
Q

Describe control of external sphincter

A
  • Voluntary
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24
Q

What happens when bladder fills

A

Bladder fills trigger stretch receptors that sign spinal cord (S2,S3) and pontine micturition centre to increase parasympathetic stimulation causing detrusor to contract and internal sphincter to relax. It also decreases motor nerve stimulation to external sphincter.

25
Q

If wanting to voluntary inhibit urination what happens

A

Pontine centre inhibitors

26
Q

what happens in urge incontinence

A

neurogenic disorders cause autonomous contraction of detrusor and uncontrollable micturition

27
Q

what happens in stress incontinence

A

increase intra-abdominal pressure causes pressure inside abdomen to overcome sphincter pressure - leading to incontinence.

28
Q

what is first line investigation for use incontinence

A

Urinalysis

29
Q

what is looked for on urinalysis

A
  • Glycosuria

- Nitrites and haematuria

30
Q

what examination is performed in urge incontinence

A

Pelvic exam - to look for prolapse or atrophic vaginitis

31
Q

what investigation is recommended for patients with urge incontinence following urinalysis and pelvic exam

A

Bladder diary

32
Q

how long is a bladder diary kept for

A

3-days

33
Q

what does bladder diary look at

A
  • Input
  • Output
  • Urgency
  • Frequency and volume of urination
34
Q

how is post-residual volume measured

A

Bladder USS

35
Q

what is first line for managing urge incontinence

A

conservative: lifestyle advice

36
Q

what is second-line for urge incontinence

A

supervised bladder training (6-weeks)

37
Q

how long is supervised bladder training carried on for

A

6-Weeks

38
Q

what medication is offered for urgent incontinence if supervised mechanism have failed

A

Oxybutynin (Tolterodine)

39
Q

when should oxybutynin (tolteridine) not be offered and why

A

> 75-years due to exacerbating delirium. Use mirabegron instead

40
Q

how long does tolterodine take to work and hence when should patient be reviewed

A

4W

41
Q

what is fourth-line for urge incontinence

A

botulism injection in bladder

42
Q

when should incontinence pads only be used in urge incontinence

A

whilst awaiting treatment

43
Q

what is first line for investigating stress incontinence

A

Pelvic exam

44
Q

why is pelvic exam performed in stress incontinence

A
  • Look for pelvic floor weakness
45
Q

what is the stress test

A

Ask patient to cough and small amount of urine will leak out

46
Q

what is performed prior to surgery in women with stress incontinence

A

Urodynamic studies

47
Q

what is first-line for stress incontinence

A

Conservative: lifestyle advice

48
Q

what 4 pieces of lifestyle advice may be given

A
  1. Smoking cessation
  2. Reduce caffeine
  3. Reduce alcohol
  4. Weight loss
49
Q

what is second-line management of stress incontinence

A

supervised pelvic floor training

50
Q

what is supervised pelvic floor muscle training also known as

A

Kegel exercises

51
Q

what are kegel exercises

A

8 contractions, 3 times a day - for 3-months

52
Q

if Kegel exercises have failed what is offered

A

Surgery

53
Q

what types of surgery may be offered for stress incontinence

A

Mid-urethral tape
Colposuspension
Rectal-fascial sling
Bulking agents

54
Q

if a patient is unsuitable for surgery, what is indicated

A

Duolextine

55
Q

what is the MOA of duolextine

A

NA and 5-HT re-uptake inhibitor

56
Q

what is the pelvic floor made up of

A

levator ani

Coccygeus

57
Q

what is the levator ani made up of

A
  • Illiococcygeus
  • Puborectalis
  • Pubococcygeus
58
Q

what is overactive bladder syndrome

A

urgency without urge incontinence

Urology (14 decks)

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