5.03 Urology - The Bladder Flashcards
What is urinary incontinence?
The involuntary leakage of urine
What are the subtypes of urinary incontinence?
- stress incontinence
- urge incontinence
- mixed incontinence
- overflow incontinence
- continuous incontinence
What is stress UI?
Urine leakage when intra-abdominal pressure exceeds urethral pressure, for example when coughing or laughing.
Stress UI is commonly seen post-partum, due to damage to the pelvic floor muscles.
What is urge UI?
Overactive bladder leading to uninhibited bladder contraction, leading to a rise in intravesical pressure and subsequent leakage of urine.
Urge UI may be due to neurogenic causes, infection, malignancy or idiopathic.
What is mixed UI?
A combination of stress UI and urge UI
What is overflow UI?
Usually a complication of chronic urinary retention, whereby there is progressive stretching and desensitisation of the bladder.
As intravesical pressure builds, there is a constant dribbling of urine.
Commonly due to prostatic hyperplasia.
What is continuous UI?
The constant leakage of urine, typically due to anatomical abnormality or bladder fistulae.
May also be a complication of severe overflow incontinence.
How can the severity of urinary incontinence be quantified?
- ask patient to keep bladder diaries
- QoL questionnaires (e.g. ICIQ)
What investigations should be considered for those with urinary incontinence?
- midstream urine dipstick
- post-void bladder scans
If aetiology unclear, further urodynamic assessment and cystoscopy can be used to determine the cause.
What lifestyle advice can be given to a patient to manage urinary incontinence?
- weight loss
- reduce caffeine intake
- avoid drinking excessive fluid volumes
- smoking cessation
What conservative management can be used to control stress UI?
Pelvic floor muscle training for at least three months.
Limited response to PFMT, offer duloxetine.
What is the action of duloxetine in the treatment of stress UI?
Sertotonin-norepinephrine reuptake inhibitor, causing stronger urethral contractions.
What conservative management can be used to treat urge incontinence?
Anti-muscarinic drugs can be trialled, for example oxybutynin.
Bladder training should also be offered, ensuring this is continued for around 6 weeks.
If conservative management of urinary incontinence fails, what surgical treatment options are there?
- butolium toxin A injections
- tension free vaginal tape
What is the most common tumour of the urinary system?
Bladder cancer
What are the risk factors for bladder cancer?
- smoking
- increasing age
- exposure to industrial dyes or rubber
- schistosomiasis infection
- radiation to pelvis
What are the types of bladder cancer?
- transitional cell carcinoma (most common)
- squamous cell carcinoma (rare)
- adenocarcinoma
- sarcoma (rare)
What are the four layers of the bladder wall?
Inner lining: urothelium
Second layer: lamina propria
Third layer: muscularis propria
Fourth layer: fatty connective tissue
What are the clinical features of bladder cancer?
- painless haematuria
- recurrent UTIs
- LUTS
How is bladder cancer staged?
TNM staging
Tumour size
Nodal involvement
Metastases
What are the differential diagnoses of bladder cancer?
- UTIs
- renal calculi
- prostate cancer
- renal cancer
What are the investigations for suspected bladder cancer?
- urgent cystoscopy
- biopsy of tumour by TURBT
- CT staging
- urine cytology
How is non-muscle-invasive bladder cancer managed?
In early stages, can be resected using TURBT.
If high-risk or advanced disease, can offer intravesical BCG therapy, or radical cystectomy.
How is muscle-invasive bladder cancer managed?
Radical cystectomy + neoadjuvant chemotherapy
How is locally advanced or metastatic bladder cancer managed?
- chemotherapy
- manage symptoms
- palliative options discussed
What is the prognosis of bladder cancer?
Prognosis is usually good, unless disease is highly advanced or metastasised.
