5.03 Urology - The Bladder Flashcards

1
Q

What is urinary incontinence?

A

The involuntary leakage of urine

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2
Q

What are the subtypes of urinary incontinence?

A
  • stress incontinence
  • urge incontinence
  • mixed incontinence
  • overflow incontinence
  • continuous incontinence
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3
Q

What is stress UI?

A

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.

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4
Q

What is urge UI?

A

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.

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5
Q

What is mixed UI?

A

A combination of stress UI and urge UI

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6
Q

What is overflow UI?

A

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.

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7
Q

What is continuous UI?

A

The constant leakage of urine, typically due to anatomical abnormality or bladder fistulae.

May also be a complication of severe overflow incontinence.

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8
Q

How can the severity of urinary incontinence be quantified?

A
  • ask patient to keep bladder diaries
  • QoL questionnaires (e.g. ICIQ)
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9
Q

What investigations should be considered for those with urinary incontinence?

A
  • midstream urine dipstick
  • post-void bladder scans

If aetiology unclear, further urodynamic assessment and cystoscopy can be used to determine the cause.

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10
Q

What lifestyle advice can be given to a patient to manage urinary incontinence?

A
  • weight loss
  • reduce caffeine intake
  • avoid drinking excessive fluid volumes
  • smoking cessation
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11
Q

What conservative management can be used to control stress UI?

A

Pelvic floor muscle training for at least three months.

Limited response to PFMT, offer duloxetine.

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12
Q

What is the action of duloxetine in the treatment of stress UI?

A

Sertotonin-norepinephrine reuptake inhibitor, causing stronger urethral contractions.

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13
Q

What conservative management can be used to treat urge incontinence?

A

Anti-muscarinic drugs can be trialled, for example oxybutynin.

Bladder training should also be offered, ensuring this is continued for around 6 weeks.

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14
Q

If conservative management of urinary incontinence fails, what surgical treatment options are there?

A
  • butolium toxin A injections
  • tension free vaginal tape
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15
Q

What is the most common tumour of the urinary system?

A

Bladder cancer

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16
Q

What are the risk factors for bladder cancer?

A
  • smoking
  • increasing age
  • exposure to industrial dyes or rubber
  • schistosomiasis infection
  • radiation to pelvis
17
Q

What are the types of bladder cancer?

A
  • transitional cell carcinoma (most common)
  • squamous cell carcinoma (rare)
  • adenocarcinoma
  • sarcoma (rare)
18
Q

What are the four layers of the bladder wall?

A

Inner lining: urothelium

Second layer: lamina propria

Third layer: muscularis propria

Fourth layer: fatty connective tissue

19
Q

What are the clinical features of bladder cancer?

A
  • painless haematuria
  • recurrent UTIs
  • LUTS
20
Q

How is bladder cancer staged?

A

TNM staging

Tumour size

Nodal involvement

Metastases

21
Q

What are the differential diagnoses of bladder cancer?

A
  • UTIs
  • renal calculi
  • prostate cancer
  • renal cancer
22
Q

What are the investigations for suspected bladder cancer?

A
  • urgent cystoscopy
  • biopsy of tumour by TURBT
  • CT staging
  • urine cytology
23
Q

How is non-muscle-invasive bladder cancer managed?

A

In early stages, can be resected using TURBT.

If high-risk or advanced disease, can offer intravesical BCG therapy, or radical cystectomy.

24
Q

How is muscle-invasive bladder cancer managed?

A

Radical cystectomy + neoadjuvant chemotherapy

25
Q

How is locally advanced or metastatic bladder cancer managed?

A
  • chemotherapy
  • manage symptoms
  • palliative options discussed
26
Q

What is the prognosis of bladder cancer?

A

Prognosis is usually good, unless disease is highly advanced or metastasised.