Bladder and urinary disorders Flashcards
four main sub classes of urinary incontinence
Stress, urge, mixed and overfloew
What is stress incontinence?
leakage on effort of exertion e.g. cough/sneeze due to pelvic floor weakness / damage to urethral sphincter
What is urgency incontinence?
involuntary leakage which is accompanied or immediately preceded by sudden compelling desire to pass urine that is difficult ot delay
Urgency incontinence is often part of a larder symptom complex known as what?
Overactive bladder syndrome
Non drug treatment for unrinary incontinence
modify fluid intake, BMI (if >30), reduction in caffeine, absorbent products
For urge incontinence, what is the first line treatment in women?
Bladder training for at least 6 weeks
For stress incontinence, what is first line treatment?
Pelvic floor training for at least 3 months which should include 8 contractions performed 3 times a day
What test should be done for all women presenting with urinary incontinence?
Urine dipstick
If a women is >45, has heamaturia without UTI what should be done?
Urgent referral
First line medication for urge incontinence
Anticholingergic drug e.g. Oxybutynin or tolerodine or darifenacin
Which anticholinergic should not be used in frail, older women with sudden deterioration in their physical / mental health
Oxybutynin I/R capsules
If treatment for urge incontinence cannot be managed wiht an anticholinergic, what else can be trialled?
Mirabegron
What an be used for troublesome nocturia?
Desmopressin
What can be used second line for stress incontinence if pelvic floor exercise has failed?
Duloxetine
By what age are children expected to no longer expereince nocturnal enuresis?
5 years
What non drug treatment should be given for nocturnal enuresis in children?
fluid intake, diet, toileting behaviour and reward systems. If the child does not respond to this advice (more than 1-2 wet beds a week) then an alarm should be introduced.
What drug treatment is first line for children with nocturnal enuresis?
Desmopressin oral or sublingual ( need to be gradually withdrawn over 3 monthd
What TCA can be used in children who have not responcded to all toher treamtents for nocturnal enuresis?
Imipramine
Can antimuscarinics be used in angle closure glaucome?
NO
Can antimuscarinics be used in myasthenia gravis?
no
What urinary condition are antimuscarinics contraindicated in?
Urinary retention
Side effects of antimuscarinics
Constipation, dizziness, dry mouth, dyspepsia, flushing, headache, nausea, tacycardia,urinary disorders, vision disorders
how often does an oxybutynin patch need to be replaced?
3 to 4 days
Example of a beta 3 adrenoreceptor agonists?
Mirabegron
When is mirabegron contraindicated?
In severe uncontrolled hypertension (>180 systolic, 110 diastolic)
What needs to be monitored during and throughouth treatment with mirabegron>
BP
Most common cause of urinary retention?
BPH
What is used to relieve painful, acute urinary retention
Catherisation
What drug class should be given for 2 days before removing a catherter?
Alphsa blocker
First line drug treamtent for moderate-severe urinary retention in men?
Alphas blocker e.g. tamsulosin, doxasozin
First line treatment for BPH
Tamsulosin
If ap atient has an enlarged prostate, raised prostate specfic antigen and is at highrisk of progression, what drug(s) can be offered?
Finateride or dutasteride ( 5 alpha reductase inhibitors)
When should the first dose of an alpha inhibitor be taken?
Before bed - risk of postural drop
What eye condition are alpha blockers cautioned in?
History of cataracts
Women of child bearing potential should handle which medications used for BPH with caution?
Dutasteride and Finasteride
MHRA alert associated with Finasteride
risk of suicidal reports / depression
Patients on finasteride need to be counselled about the risk of what maligancy?
Breast cancer
Risk factoe associated with forming renal stones?
dehydration, change in urine pH, males aged 40-60, family hisotry, obesity, excessive intke of oxalate, sodium and uric acid, some drugs e.g. calcium supplementes, protease inhibitors,diuretics
What could a patient be diagnosed with if they have a sudden, abrupt onset of severe unilateral pain radiating tothe groin +/- nausea, increased urinary frequency,dysuria, fever?
Renal stones
Maximum salt intake recomendation
6g a day
First line analgesia for renal colic
NSAIDS (if unsuitable IV paracetamol)
What can be used to alkalise urine?
Potassium citrate
Pentosan polysulfate sodium is used for bladder pain syndrome - what is the associated MHRA alert?
Rare risk of pigmentary maculopathy - pt need regualr ophthalmic examinsation
