8 - Gynae - Disorders of the Urinary Tract - Other Urinary Disorders

Question 1

5 other disorders (a few have 2 things grouped)

Answer 1

Mixed USI and OAB
Acute urinary retention
chronic retention and urinary overflow
painful bladder syndrome and interstitial cystitis
fistulae

Question 2

Mixed USI and OAB - ? % of all incont cases.
how diagnosed?
what are trtd first?

Answer 2

10% of all incont cases
cystometry
most bothersome Sx

Question 3

Acute urinary retention - pt unable to pass urine for ? or more, ? produces as much/more than normal bladder capacity. When is this not painful?

Answer 3

12h or more
catheterisation
if due to epidural anaesthesia/failure of afferent pathways

Question 4

Acute urinary retention - causes

• ? (esp w epidural)
• ? or ? pain eg HSV
• surgery
• drugs eg ?
• ? ? uterus
• pelvic ?
• neuro disease eg ?/?
• what must be done for 48h whilst cause treated?

Answer 4

childbirth, vulval, perineal, anticholinergics, retroverted gravid uterus, masses, MS/CVA

catheter

Question 5

Chronic retention and urinary overflow - 1% of cases

• leaking due to bladder ?
• due to either ? obstruction or ? inactivity
• common causes of this are pelvic ? and ? surgery.
• what two things can cause detrusor inactivity?

Answer 5

overdistension
urethral
detrusor
masses 
incontinence
prev overdistension of bladder or autonomic neuropathies eg DM

Question 6

Chronic retention and urinary overflow - presentation may mimic what? or urinary loss may be ?

• what does Ex reveal?
• Dx confirmed by ? or ? after micturition
• what is commonly required of the patient?

Answer 6

Stress incont
continuous
distended non-tender bladder
USS or catheterisation after mic
intermittent self-catheterisation

Question 7

Painful bladder syndrome and Interstitial cystitis - PBS is where pt has ? pain related to bladder ?
-in absence of ? or other obvious pathology

Interstitial cystitis Dx is confined to pts with ? bladder Sx w characteristic ? and ? features.
TRT - two conservative measures? 2 drugs? or intravesical infusion of various drugs

Answer 7

suprapubic, filling, UTI

painful
cystoscopic and histo

dietary changes, bladder training
TCAS, Analgesics

Question 8

Fistulae - most commonly ? and ?
rare in west but usually due to ?, ? or malignancy.
Ix with CT ? or ?
small fistulae resolve ? but surgery usually req - timing depends on ? and ?

cause in dev world?

Answer 8

urethrovaginal or vesicovaginal
surgery, RTx, malignancy
CT urogram or cystoscopy
spont
site and cause

obstructed labour