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Urinary > 8.2 Urinary Incontinence > Flashcards

8.2 Urinary Incontinence Flashcards

1
Q

At what vertebral level does the spinal cord end?

A

L2

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2
Q

What nerve supplies detrusor muscle?

A

Parasympathetic via the pelvic nerve (S2, S3, S4)

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3
Q

What is the levator ani?

A

The pelvic floor muscle

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4
Q

What are the 2 main phases of bladder continence?

A

Storage phase

Voiding phase

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5
Q

What occurs to continence when there is a lesion of the lower motor neurone?

A 
Low detrusor muscle pressure -> large residual volume of urine
Overflow incontinence (esp. when lying down at night)
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6
Q

What neurones must be affected to influence continence?

A

S2 S3 S4

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7
Q

What other symptoms are associated with a lower motor neurone lesion?

A

Reduced perianal sensation

Lax anal tone

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8
Q

What happen to continence in an upper motor neurone lesion?

A

Detrusor sphincter dyssynergia

High pressure detrusor contractions
Poor coordination with external sphincter
Leads to thickened detrusor muscle and dilated ureters

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9
Q

What 3 categories are considered in lower urinary tract symptoms?

A

Storage
Voiding
Post-micturation

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10
Q

What are storage symptoms?

A

Increased frequency
Urgency
Nocturia
Incontinence

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11
Q

What are voiding symptoms?

A 
Slow stream
Splitting or spraying
Intermittency
Hesitancy
Straining
Terminal dribble
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12
Q

What are post-micturition symptoms?

A

Post-micturation dribble

Feeling of incomplete emptying

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13
Q

Increase in abdominal pressure can cause incontinence. Give some examples of things that would cause an increase in abdominal pressure

A

Coughing
Obesity
Pregnancy

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14
Q

What are the 4 main types of incontinence?

A

Stress urinary incontinence
Urgency urinary incontinence
Mixed urinary incontinence
Overflow incontinence

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15
Q

What is stress incontinence?

A

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

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16
Q

What is Urgency urinary incontinence?

A

The complaint of involuntary leakage of urine accompanied by or immediately preceded by urgency

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17
Q

What is mixed urinary incontinence?

A

The complaint of involuntary leakage of urine with urgency and also with exertion, effort, sneezing or coughing

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18
Q

What is overflow incontinence?

A

When people have chronic painless retention

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19
Q

What are the symptoms of an overactive bladder?

A

Urgency
Increased frequency
Nocturia
Urgent urinary incontinence

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20
Q

What is the most common type of incontinence?

A

Stress urinary incontinence

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21
Q

What are the obs and gynae risk factors for urinary incontinence?

A

Pregnancy and childbirth (esp vaginal delivery)
Pelvic surgery
Radiotherapy (makes bladder less compliant)
Pelvic prolapse

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22
Q

What are the predisposing risk factors to urinary incontinence?

A

H

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23
Q

What are the promoting risk factors of urinary incontinence?

A 
Menopause -> less oestrogen 
Drugs
UTI
Increased abdominal pressure
Obesity 
Age
Co-morbidities 
Cognitive impairment (dementia)
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24
Q

What should be done in a urinary incontinence consultation?

A

History - categorise the type of UI
Examination - BMI, Abdominal exam to exclude a palpable bladder, digital rectal examination (males-prostate), limited neurological examination - perianal sensation and anal tone
Females - examine external genitalia (stress test), vaginal exam (prolapse)

25
Q

What are investigations done for UI?

A 
Urine dipstick
Frequency-volume chart
Bladder diary
Post-micturition residual volume
Invasive urodynamics
Pad tests
Cystoscopy
26
Q

What is the conservative management of UI

A 
Modify fluid intake
Weight loss
Stop smoking
Decrease caffeine intake
Avoid constipation
Timed voiding - fixed schedule
27
Q

When is contained incontinence used?

A

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

28
Q

Give examples of contained incontinence

A

Indwelling catheter (urethral/suprapubic)
Sheath device
Incontinence pads

29
Q

What is the initial management of SUI?

A

Pelvic floor muscle training

  • 8 contractions x3/day
  • at least 3 months duration
30
Q

What is the pharmacological management of SUI?

A

Duloxetine - increases activity in the striated sphincter during filling phase (alternative to surgery). Makes people feel nauseous

31
Q

What surgery is done for SUI in females?

A

Permanent intention

  • open retropubic suspension procedures
  • classical autologous sling procedures
  • low-tension vaginal tapes

Temporary intention
- intramural bulking agents

32
Q

What surgery can be done for males with SUI?

A

Artificial urinary sphincter

Male sling procedure

33
Q

What is the function of retropubic suspension procedures?

A

To correct the anatomical position of proximal urethra and improve urethral support

34
Q

What is the function of classical facial sling procedures?

A

To support the urethra and augment bladder outflow resistance

35
Q

What are the benefits and disadvantages of low-tension vaginal tapes?

A

Good - high success rates, minimally invasive technique, supports mid urethra

Bad - 10% of patients get pain and vaginal problems

36
Q

What are intramural bulking agents?

A

Injections (autologous fat/silicone/collagen/hyaluronic-dextran polymers) under GA/LA into the mucosa of the urethra. Improves the ability of the urethra to resist abdominal pressure by improving urethral coaptation. Needs regular top up

37
Q

What is the male urethral sphincter?

A

Used to treat long term male wetness due to urethral sphincter deficiency (neurological/surgical/post pelvic radiotherapy). Cuff simulates action of normal sphincter to circumferentially close the urethra. Button in the scrotum. Mechanical device. Gold standard

38
Q

What is the initial management of UUI?

A

Bladder training - schedule voiding, at least 6 weeks in duration, increasing intervals between voiding

39
Q

What are the pharmalogical managements for UUI?

A

Anticholinergenics - block muscarinic receptors (M2, M3), side affects as muscarinic receptors in other organs. Dryness of mouth, constipation.

Beta 3 adrenoceptor agonist - relax the bladder, increasing the bladders capacity to store urine.

40
Q

What are common types of anticholinergics?

A

Oxybutynin

Solifenacin

41
Q

What is mirabegron?

A

A type of beta3-adrenoceptor agonist. Shouldn’t be given to people with high blood pressure.

42
Q

If patients have heart conditions and high BP, what can be used for pharmacological management of UUI?

A

Intravascular injection of botulinum toxin to bladder. Potent biological neurotoxin. Inhibits release of Ach at pre-synaptic neuromuscular junction causing targeted flaccid paralysis. Acts for 3/6 months.

43
Q

What is the surgical intervention for UUI/?

A

Sacral nerve neuromodulation
Autoaugmentation
Urinary diversion
- only done in fit young people as a last option

44
Q

What is enuresis?

A

Involuntary wetting during sleep at least twice a week in children aged 5+ with no CNS defects

45
Q

What key questions need to be asked during enuresis?

A 
Age?
Primary or secondary?
Daytime symptoms?
Pain passing urine?
Infrequent urination?
Constipated?
46
Q

What is primary enuresis?

A

Enuresis having never achieved sustained continence at night

47
Q

What is secondary enuresis?

A

Enuresis restarting after having been dry at night for 6+ months

48
Q

What is the management of primary enuresis without daytime symptoms?

A

Reassurance, alarms with positive reward. Desmopressin

49
Q

What is the management of primary enuresis with daytime symptoms?

A

Usually caused by disorders of the lower urinary tract

Refer to secondary care

50
Q

How is secondary enuresis managed?

A

Identify underlying cause and treat.

51
Q

what causes SUI?

A

Pelvic floor laxity (chilbirth)
bladder neck sphincter impairment
surgery affecting the urethra or prostate

52
Q

what is Duloxetine?

A

a serotonin and noradrenaline reuptake inhibitor used to treat stress incontinence

53
Q

How do low-tension vaginal tapes help SUI?

A

proximal urethra is lifted with an artificial sling, increases in intra-abdominal pressure compress the urethra

54
Q

What is UUI?

A

Urgency urinary incontinence is the sudden strong urge to void followed immediately by the involuntary loss of urine. Part of over reactive bladder syndrome

55
Q

what is overreactive bladder syndrome?

A

overactivity of the detrusor muscle

56
Q

what are the causes of overflow incontinence?

A

chronic urinary retention
outlet obstruction (faecal impaction, benign prostatic hypertrophy)
atonic bladder
bladder neck stricture

57
Q

what are the causes of continuous incontinence?

A

vesicovaginal fistulae

ectopic ureter bypassing urine from the kidney to the urethra or vagina

58
Q

what is functional incontinence?

A

incontinence due to severe cognitive impairment or mobility issues, preventing use of toilet.bladder function is normal

Urinary (18 decks)

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