8 - Gynae - Disorders of the Urinary Tract - Overactive Bladder

Question 1

urinary Sx - ?, w or w/o urge incont, usually with ? or ?, in absence of proven ?
The Sx combo suggests ? over-activity - but can be other ? ? dysfx

Answer 1

urgency, freq or nocturia
infection
detrusor
urinary tract

Question 2

Detrusor overactivity - characterised by ? detrusor ? during the ? phase - may be ? or provoked eg after ?
OAB and DOA can happen ? or ?

OAB = ?% of female incontinence

Answer 2

involuntary contraction
filling
spont/provoked - coughing
alone or together

35%

Question 3

Aetiology - mostly what?

• can follow what? (prob due to ? ? obstruction)
• occasionally OAB is due to ??, in presence of underlying ? eg ? or sub cut injury

Answer 3

idiopathic
ops for USI - bladder neck obstruction
DOA
neuropathy
MS

Question 4

Mechanism of incontinence - detrusor contraction normally felt as ?

• if strong enough can cause what? leading to urge incontinence.
• can occur ? or with ? eg ? ? or a running tap
• therefore coughing may give leakage - which is easily confused with ? ?

Answer 4

urgency
bladder press > urethral > leakage = urge incontinence
spont or w provocation - incr IAP
-stress incontinence

Question 5

Hx points - 4 urinary Sx that are usual?

• what other urinary Sx is common?
• some pts leak at ? or at ?
• Hx of childhood ? common, as is faecal ?

Ex - often normal, incidental ? may be found

Answer 5

urgency, urge incont, freq, nocturia
stress incont
night or at orgasm
enuresis
faecal urgency

cystocoele

Question 6

Ix

• What will urinary diary show? what may it show?
• with DOA - cystometry shows contractions on ? or ?
• cystometry not gen done until what? (few things)

Answer 6

freq passing of small vol of urine, esp at night, may show high intake of caffeinated drinks
filling or provocation
failure of lifestyle changes and drug management OR if surgery considered

Question 7

MGMT - conservative - 2 simple pieces of advice? avoid which 2 drugs types?
-what other conservative trt? what is it often in combo with?

Answer 7

avoid caffeine, drink less
diuretics and anti-psychs
bladder training
anticholinergic therapy

Question 8

MGMT - medical - ? suppress DOA, most widely used.

• they ? the detrusor
• one key SE?
• what to do if this doesnt help Sx?
• 2 other medical trts?

Answer 8

anticholinergics
relax
dry mouth
refer to specialist

oestrogens
Botulinum Toxin A (BTX)

Question 9

How does oestrogen work ?

and BTX? 2 common complx of BTX?

Answer 9

o - good for post menopause, improves Sx of vag atrophy (dryness/irritation) and reduces urinary Sxs
BTX - weakens muscle - injected into detrusor - voiding dysfx and retention (5-20%)