Bladder and urinary disorders Flashcards
• Methods for managing urinary incontinence include
pelvic floor exercises and bladder training
licensed for use in moderate to severe stress incontinence in women
• Duloxetine is licensed for use in moderate to severe stress incontinence in women. It may be more effective when used as an adjunct to pelvic floor exercises.
Antimuscarinic drugs examples
Oxybutynin, Tolterodine and Solifenacin
Antimuscarinic drugs such as Oxybutynin
reduce the urge to urinate and increase bladder capacity.
Side effects of Oxybutynin
- Side effects limit the use of Oxybutynin, but they may be reduced by starting at a lower dose.
- A modified-release preparation is effective and has fewer side effects.
a selective beta3 agonist
• Mirabegron, a selective beta3 agonist is licensed for the treatment of urinary incontinence associated with overactive bladder syndrome. Caution: QT interval prolongation
Nocturnal enuresis is
the involuntary discharge of urine during sleep, which is common in young children.
Children are expected to be
dry by a developmental age of 5 years.
Nocturnal enuresis treatment
- If changes to fluid intake, diet and toileting behaviour are ineffective (more than 1-2 wet beds per week) … an enuresis alarm is recommended (continue until 2 weeks of uninterrupted dry nights.
- If the alarm use is inappropriate or undesirable, then treatment with oral/sublingual desmopressin is recommended for children over 5 years. Side effect of desmopressin in hyponatraemic convulsions.
Stop desmopressin in
vomiting/diarrhoea until normal fluid balance. Avoid concomitant drugs that increase vasopressin secretion (TCAs)
Urinary retention is
the inability to voluntarily urinate.
- Acute urinary retention is
a medical emergency characterised by the abrupt development of inability to pass urine (over a period of hours)
CHRONIC urinary retention is
- gradual (over months/years) development of inability to empty bladder completely, characterised by a residual volume greater than 1 litre or distended/palpable bladder
The most common cause of urinary retention in men is
Benign Prostatic Hyperplasia (enlarged prostate)
Treatment of acute urinary retention
• Catheterisation is carried out immediately. Before the catheter is removed… an alpha adrenoceptor blocker (e.g. Alfuzosin, Tamsulosin, Doxazosin, Prazosin, Indoramin or Terazosin), should be given for atleast 2 days to manage acute urinary retention.
Treatment of chronic urinary retention
- Intermittent bladder catheterisation should be offered before an indwelling catheter.
- In men who have symptoms that are bothersome, drug treatment should only be offered when other management options have failed.
- Men with moderate-severe symptoms should be offered an alpha-adrenoceptor blocker (alfuzosin, Tamsulosin or Doxazosin). Review treatment initially after 4-6 weeks and then every 6-12 months.
Treatment of urinary retention due to Benign Prostatic Hyperplasia
- An alpha-adrenoceptor blocker, these drugs relax smooth muscle in BPH producing an increase in urinary flow rate and an improvement in obstructive symptoms.
- In patients with an enlarged prostate and who are considered to be at high risk of progression (e.g. elderly) a 5a reductase inhibitor (Finasteride/Dutasteride) can be used (also in combination with above)
Alpha-adrenoceptor blockers examples, Patient counselling + side effects
examples - doxazosin, alfuzosin, tamsulosin
The first dose may cause hypotension, so it should be taken at night, following this the next doses should be taken in the morning.
- side effects: male breast tissue (report lumps, pain or nipple discharge), depression + suicidal thoughts (stop + report)
Finasteride is not prescribable in
NHS for treatment of androgenetic alopecia in men
5a-reductase inhibitors example and cautions
- Finasteride + duasteride
- Conception and Contraception: both drugs are excreted in the semen and use of a condom is recommended if sexual partner is pregnant or likely to become pregnant
- Handling and storage: women of childbearing potential should avoid handling leaking capsules of Dutasteride and crushed or broken tablets of Finasteride
- Patient and carer advice: cases of male breast cancer have been reported. Patients should report any changes in breast tissue such as lumps, pain or nipple discharge.
- MHRA: Rare reports of depression and suicidal thoughts in men taking finasteride (Propecia/Proscar)
