Bladder and urinary disorders Flashcards
types of urinary incontincence
stress - involuntary leakage on effect or exertion
urgency - involuntary leakage accompanied by sudden desire to pass urine
mixed - involuntary leakage associated with stress and urgency
overflow - complication of chronic urinaary retention - person can’t empty bladder completely - leads ro frequent loss of small quantities of urine
conditions that increase detester muscle overactivity
UTI
CNS - parkinsons
endocrine - diabetes
risk factors for bladder disorders
older age pregnancy vaginal delivery family history obesity constipation smoking lack of supporting tissue drugs - ACE and alfa adrenergic blockers
drugs with side effects that lead to increase in detrusor muscle activity
cholinesterase inhibitors., constipating drugs, those with anticholinergic effects,
how do diuretics.alcohol, caffeine worsen urinary
inc urine production, polyuria, frequency, urgency, nocturne
treatment for women
6 weeks of bladder training
IR oxybutinin, IR tolteridine, darfenicin
treatment for women with urgency incontinence
6 weeks of bladder training
IR oxybutinin, IR tolteridine, darfenicin
Treatment should be reviewed after 4 weeks, or sooner if required.
If treatment is effective review the woman again at 12 weeks,
then annually thereafter, or every 6 months if the woman is over 75 years of age.
If treatment not effective/ tolerated an alternative anticholinergic drug can be used, the current dose adjusted or, mirabegron trialled; review again after 4 weeks.
Alternative anticholinergics include, an untried first-line drug, or one of the following; fesoterodine fumarate, propiverine hydrochloride, solifenacin succinate, trospium chloride, or an extended release formulation of either oxybutynin hydrochloride or tolterodine tartrate.
failing all this Women should be referred to secondary care, where treatment with botulinum toxin type A or surgical methods may be considered.
acute urinary retention
abrupt development of the inability to pass urine - over a few hours
most common cause of chronic urinairy retention in men
benign prostatic hyperplasia - enlarged prostate
treatment of chronic urinary retention
intermittent bladder cauterisation should be offered first before indwelling catheter
for those with bothersome symptoms or mod to severe - drug treatment with alpha blockers
treatment of acute urinary retention
immediate treatment by catheterisation and treatment with alpha blockers for a
treatment of mixed urinary incontinence
Women should trial both bladder training for at least 6 weeks and supervised pelvic floor muscle training for at least 3 months, which should include at least 8 contractions performed 3 times per day. If frequency is a problem and satisfactory benefit from bladder training is not achieved, drug treatment for an overactive bladder should be added.
how often do you review treatment for men with chronic urinary retention
initially after 4-6 weeks and then every 6 to 12 months
urinary retention due to
watchful waiting no complications e.g. renal impairement, urinary retention or infections
alpha adrenoreceptor blockers recommended treatment
raised PSA, progressive disease
5a reductase - finasteride and dutasteride
side effects of finasteride
sexual dysfunction
decreased libido
depression and suicidal thoughts
