Bladder conditions Flashcards
incontinence definition
any involuntary leakage of urine
types of incontinence (4)
stress
urge
overflow
mixed (stress and urge)
what is the problem in stress incontinence
what can cause this (4)
insufficient pelvic floor strength
child birth
obesity
smoking (chronic cough)
old age
when does the leakage of urine occur in stress incontinence
when coughing/sneezing/exercising/laughing
what is the problem in urge incontinence
detrusor/bladder overactivity
when does the leakage occur in urge incontinence
when is it worse
when hearing running water/opening a door/standing up/key in the door
worse when drinking alcohol/coffee
which type of incontinence presents with frequency and urgency
urge
what is the most common type of incontinence
mixed - urge and stress
what can cause overflow obstruction
bladder outflow obstruction eg benign prostatic hyperplasia
which type of incontinence presents with constant dribbling
overflow incontinence
investigations for incontinence (5)
lower abdo exam urinalysis for infection U&Es for renal impairment bladder diary urodynamics
what do you want to ask someone that comes in with incontinence
does it happen when you cough/sneeze
or
does it happen when you hearing water running/stand up
where are the 2 probes in urodynamics
what else do you need
what are you trying to figure out
one in bladder
one in rectum/vagina
catheter in bladder
detrusor muscle pressure in different situations (eg coughing)
conservative treatment for stress incontinence
stop smoking
weight loss
pelvic floor exercises
‘learn to hold your pee’
surgical treatment for stress incontinence
transvaginal tape
conservative treatment for urge incontinence
reduce caffeine
reduce fluids
bladder training
surgical treatment for urge incontinence
botulinum toxin (botox)
drug for stress incontinence
is it used
duloxetine
not really only temporary - suicidal thoughts side effects
drug for urge incontinence
is it used
oxybutynin
yes
how does oxybutynin work in urge incontinence
antimuscarinic drug = decreases detrusor muscle activity
treatment of overflow incontinence
catheter to drain urine
fix problem
what other symptoms is overflow incontinence associated with
nocturia
poor flow
urinary retention (chronic and painless, or acute and painful)
examination of someone with overflow incontinence
abdo exam (fluid retention) neuro exam (eg spinal cord abnormalities)
males - PR exam for prostate, penis inspection
females - vaginal inspection
most common bladder cancer
transitional cell carcinoma
bladder cancer associated with schistomiasis and catheters
squamous cell carcinoma
bladder cancer associated with cystitis cystica
adenocarcinoma
most common part of bladder for transitional cell carcinoma
trigone
risk factors for transitional cell carcinoma (4)
dyes
smoking
men
>50 y/o
presentation of bladder cancer
painless haematuria
investigations for transitional cell carcinoma (2)
CT urogram (can see a half filled bladder) flexible cystoscopy
what does transitional cell carcinoma of the bladder look like on flexible cystoscopy
sea anemone
treatment of transitional cell carcinoma of the bladder (3)
TURBT (transurethral resection of bladder tumour)
cystectomy (removal of part of bladder if detrusor muscle involved)
stoma for urinary diversion
what may happen to the kidneys in someone with a bladder cancer
hydronephrosis
are bladder cancers likely to reoccur
yes
need to give them follow ups
what is cystitis
inflammation of the bladder
from infectious or non infectious causes
where does tuberculosis spread from if it infects the bladder
kidneys (from tuberculose pyelonephritis)
where do people present with schistomiasis bladder infections
Africa (tropical countries)
painless frank haematuria
bladder cancer
