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Urinary > 8. Urinary Incontinence > Flashcards

8. Urinary Incontinence Flashcards

1
Q

What is the muscle of the bladder?

A

Detrusor

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2
Q

What is the innervation of the detrusor muscle?

A

Parasympathetic S2,3,4

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3
Q

What is the innervation of the internal sphincter?

A

Somatic - pudendal nerve S2,3,4

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4
Q

What is the storage phase?

A

Filling of bladder
Compliance - receptive relaxation
Sensation of bladder filling
No detrusor contraction

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5
Q

What is the voiding phase?

A

Voluntary initiation

Complete emptying

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6
Q

What happens if a patient has a lower motor neurone lesion and which nerves are affected?

A

Low detrusor pressure
Large residual volume leading to overflow incontinence
Reduced perianal sensation and lax anal tone
S2,3,4

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7
Q

What happens if a patient has upper motor neurone lesion?

A 
Dilated ureters
Thickened detrusor
High pressure detrusor contractions
Poor coordination with sphincters
Detrusor sphincter dyssynergia
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8
Q

What are the lower urinary tract symptoms associated with storage phase?

A

Frequency
Urgency
Nocturia
Incontinence

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9
Q

What are the lower urinary tract symptoms associated with voiding phase?

A 
Slow stream
Splitting or spraying
Intermittency
Hesitancy
Straining
Terminal dribble
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10
Q

What are the lower urinary tract symptoms associated with post-micturition?

A

Post-micturition dribble

Feeling of incomplete emptying

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11
Q

What are the types of incontinence?

A

Stress urinary incontinence
Urgency urinary incontinence
Mixed urinary incontinence
Overflow incontinence

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12
Q

What is stress urinary incontinence?

A

The complaint of involuntary leakage on effort or exertion, or on sneezing or coughing

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13
Q

What is urgency urinary incontinence?

A

Complaint of involuntary leakage accompanied by or immediately proceeded by urgency

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14
Q

What is mixed urinary incontinence?

A

Complaint of involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing

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15
Q

What does overactive bladder include?

A

Urgency
Increased frequency
Nocturia

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16
Q

What are the risk factors for urinary incontinence?

A

Obs/gynae - Pregnancy and childbirth, Pelvic surgery, Pelvic prolapse
Predisposing - race, family predisposition, anatomical abnormalities, neurological abnormalities
Promoting - menopause, drugs, UTI, obesity, age, increased intra-abdominal pressure

17
Q

What examinations can be done when urinary incontinence is suspected?

A

BMI
Abdominal exam to exclude palpable bladder
Digital rectal examination - prostate
Females - external genitalia (stress test), vaginal exam (prolapse)

18
Q

What investigations should be done if urinary incontinence is suspected?

A

Urine dipstick - UTI, haematuria, proteinuria, glucosuria
Frequency-volume chart, bladder diary, post-micturation residual volume
Invasive urodynamics, pad tests, cystoscopy

19
Q

What are the general lifestyle interventions to help manage urinary incontinence?

A 
Modify fluid intake
Weight loss
Stop smoking
Decrease caffeine intake
Avoid constipation
Timed voiding - fixed schedule
20
Q

What is contained incontinence?

A

For patients unsuitable for surgery who have failed conservative or medical management

  • indwelling catheter (urethral or suprapubic)
  • sheath device (analogous to an adhesive condom attached to catheter tubing and bag)
  • incontinence pads
21
Q

What is the initial management for stress urinary incontinence?

A

Pelvic floor muscle training - 8 contractions 3x day, at least 3 months

22
Q

What is the pharmacological management of stress urinary incontinence?

A

Duloxetine - combine noradrenaline and serotonin uptake inhibitor, increases activity in striated sphincter during filing phase, alternative to surgery

23
Q

What are surgery options for stress urinary incontinence in females?

A

Permanent intention - open retropubic suspension procedures, classical autologous sling procedures, low-tension vaginal tapes
Temporary intention - intramural bulking agents

24
Q

Why would someone opt for a temporary intention surgery?

A

If further pregnancies are planned

25
Q

What are the surgery options for stress urinary incontinence in males?

A

Artificial urinary sphincter

Male sling procedure

26
Q

What is the aim of retropubic suspension procedures?

A

Correct anatomical position of proximal urethra and improve urethral support

27
Q

What is the aim of classic fascial sling procedures?

A

Supports the urethra and augments bladder outflow resistance

28
Q

What is the aim of intramural bulking agents?

A

Improve ability to resist abdominal pressure by improving urethral coaptation
Injections under GA/LA, autologous fat, silicone, collagen, hyaluron-dextran polymers

29
Q

What is the aim of the male artificial urinary sphincter surgery?

A

Cuff simulates action of normal sphincter to circumferentially close the urethra
Mechanical (hydraulic) device
Fix urethral sphincter deficiency

30
Q

What is the initial management of urgency urinary incontinence?

A

Bladder training

  • schedule of voiding (every hour during day, intervals increased by 15-30 mins a week until interval of 2-3 hours)
  • at least 6 weeks duration
31
Q

What are the possible pharmacological managements of urgency urinary incontinence?

A

Anticholingerics
- act on muscarinic receptors
- side effects due to affects on M receptors at other sites
Beta 3-adrenoceptor agonist
- increases bladders capacity to store urine
Intravascular injection of Botulinum toxin
- inhibits release of ACh at pre-synaptic neuromuscular junction

32
Q

Where can the side affects from anicholinergics occur?

A 
M1 - CNS, salivary glands
M2 - heart smooth muscle
M3 - smooth muscle, salivary glands
M4 - CNS
M5 - CNS, eye
33
Q

What are the surgical options for urgency urinary incontinence?

A

Sacral nerve neuromodulation
Autoaugmentation
Augmentation cystoplasty
Urinary diversion

34
Q

What is enuresis in children?

A

Bed wetting - involuntary wetting during sleep at least 2x week in children aged over 5 years with not CNS defects

35
Q

What are the questions that need to be asked in enuresis in children?

A

Age
Primary or secondary - never achieved sustained continence or restarted after 6+ months of dry nights
Do they have daytime symptoms
Do they have pain passing urine or pass urine infrequently
Are they constipated

36
Q

What is the management for enuresis in children?

A

Primary enuresis without daytime symptoms - managed in primary care, reassurance, positive reward system, desmopressin
Primary enuresis with daytime symptoms - usually caused by disorders of LUT, refer to secondary care
Secondary enuresis - treat underlying cause

37
Q

What are possible underlying causes for secondary enuresis?

A 
UTI
Constipation
Diabetes
Psychological problems
Family problems
Physical or neurological problems

Urinary (30 decks)

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