Bladder Flashcards
what is urinary incontinence
involuntary leakage of urine
more common in females
what are the subtypes of urinary incontinence
stress
urge
mixed
overflow
continuous
what is stress incontinence and what is the most common cause
leakage of urine due to increased intra-abdominal pressure such that it overcomes urethral pressure
occurs when coughing, laughing, sneezing, lifting, straining
most commonly caused due to weakness in pelvic floor muscles - commonly seen post-partum
what is urge incontinence and what is the most common cause
overactive bladder leading to uninhibited bladder contraction, rising intravesical pressure and subsequent leakage of urine
caused by overactive bladder which can be from a neurological cause, infection, malignancy, idiopathic or medication
what is overflow incontinence and what is the most common cause
due to chronic urinary retention such that progressive stretching of the bladder damages nerve fibres - so you get gross dilatation of the bladder leading to a constant dribble of urine
most common cause is BPH
what is continuous incontinence and what is the most common cause
constant leakage of urine
due to an anatomical abnormality e.g. bladder fistulae or ectopic ureter
investigations into urinary incontinence
mid-stream urine sample to check haematuria and infection
post-void bladder scan
bladder diary
urodynamic assessment
potentially a cystoscopy, MRI, etc.
lifestyle management of urinary incontinence
lose weight
reduce caffeine and alcohol intake
avoid drinking excessive volumes of fluid each day
smoking cessation
Conservative management of urinary incontinence
3 months pelvic floor exercises
Duloxetine - increases strength of urethral contractions
for urge UI - try anti-muscarinic such as oxybutynin which inhibit detrusor contraction
what drug or class of drugs would be suitable for a patient with Urge UI
anti-muscarinics e.g. oxybutynin
inhibit detrusor muscle contraction
mechanism of duloxetine
increases strength of urethral contractions - used in stress UI
surgical management of urinary incontinence
urge UI - botulinum toxin A injections
stress UI - tension free vaginal tape and equivalent in men
aetiology of bladder cancer
most common in >80 yrs
most common in men
develops from the lining of the bladder
subtypes of bladder cancer and the most common
Transitional cell carcinoma (most common 80-90% of cases)
Squamous cell carcinoma
adenocarcinoma and sarcoma (both rare)
subtypes of bladder cancer are further divided based on what
non-muscle invasive
muscle invasive
locally advanced
metastatic
what are the layers of the bladder wall
inner layer = transitional epithelium
2nd layer = connective tissue layer (lamina propria)
3rd layer = muscular layer (muscularis propria)
outer layer = fatty connective tissues
risk factors for bladder cancer
most important risk factor is smoking
exposure to industrial carcinogens e.g. dyes, etc
schistosomiasis infection (particularly important in SCC)
clinical features of bladder cancer
most common presenting complaint is painless haematuria
can also present with recurrent UTIs or LUTS
most common presenting complaint with Bladder cancer
painless haematuria
what extra symptoms would locally advanced and metastatic bladder cancer present with
locally advanced may present with pelvis pain
metastatic can present with systemic symptoms such as weight loss and lethargy - would also present with other symptoms based on where the metastases is located
investigation into suspected bladder cancer
urgent cystoscopy - then followed by a rigid cystoscopy for more definitive assessment
tumours will then require biopsy and potential CT and USS
what is the main treatment of a non-muscle invasive bladder cancer
TURBT - trans urethral resection of bladder tumour
management of muscle invasive bladder cancer
radical cystectomy - complete removal of the bladder
how is urinary diversion done in a patient who has had a radical cystectomy
ileal conduit formation (impairs B12 absorption)
or bladder reconstruction
