Bladder disorders Flashcards
What are the four types of urinary incontinence
1) stress incontinence
2) urgency incontinence
3) mixed incontinence
4) overflow incontinence
True or false:
Stress incontinence is leakage accompanied by a sudden desire to pass urine that is difficult to delay
FALSE
This described urgency incontinence
True or false:
Alpha blocking drugs increase the risk of urinary incontinence
TRUE
They relax the bladder muscles
Which drug may be used if nocturia is a problem in those with urinary urgency incontinence
Desmopressin
True or false: a vaginal oestrogen can be given to women with signs of vaginal atrophy
TRUE
It may help reduce symptoms of urinary incontinence and recurrent UTIs
At what age are children generally expected to stop bed wedding
5 years old
It is common practice to consider children for treatment only when they reach 7 years old
At what age can desmopressin be used to treat nocturnal enuresis in children
Age 5 +
True or false:
enuresis alarms have a higher relapse rate after discontinuation than drug treatment
FALSE
Relapse is more common after discontinuing drug treatment.
Imipramine has a high relapse rate
Antimuscarinics are used to treat urinary incontinence. They are contraindicated in _________ (6 points)
- myasthenia gravis
- toxic megacolon
- severe ulcerative colitis
- urinary retention
- angle closure glaucoma
- bladder outflow obstruction
True or false:
Bradycardia is an antimuscarinic side effect
FALSE
they cause tachycardia
What is the most common cause of urinary retention in men
BPH
1st line drug treatment in BPH
An alpha blocker e.g. tamsulosin
What class of drug does finasteride belong to
5 alpha reductase inhibitor
True or false:
Finasteride is excreted in semen
TRUE
Use of a condom is recommended if sexual partner is pregnant or likely to become pregnant.
Which class of analgesic is first line in renal colic
NSAIDs
What drug class does mirabegron (betmiga) belong to?
It is a Beta 3 adrenergic agonist
Used for urinary (urge) incontinence
True or false:
Duloxetine is first line in stress incontinence
FALSE
First line is pelvic floor training.
Duloxetine is second line
How long should pelvic floor training be tried for at least
16 weeks
How long should enuresis alarms be used
Until a minimum of 2 weeks of dry nights are achieved
True or false:
Acute urinary retention is a medical emergency
TRUE
It is acute if there is abrupt development of urinary retention (i.e. over a period of a few hours)
Catheter needed.
How long should bladder training last (at least)
Minimum of 6 weeks
If ineffective then consider antimuscarinics or mirabegron
How long may it take for antimuscarinics to work to alleviate incontinence symptoms ?
At least 4 weeks
Which antimuscarinics are first line for urgency incontinence ?
(3 points)
Oxybutynin (immediate release)
Tolterodine (immediate release)
Darifenacin (once daily)
NICE CKS 2019
Red flags in women presenting with urinary incontinence?
(Suspect bladder cancer)
[3 points]
Unexplained haematuria without UTI
Haematuria despite treatment of UTI
Over 60 with unexplained non-visible haematuria AND dysuria or raised WCC
Desmopressin is contraindicated in:
5 points
Hypertension
Use of diuretics
Alcohol abuse
Cardiac insufficiency
History of hyponatraemia
Side effects of desmopressin include:
5 points
Fluid retention and hyponatraemia (So CI in HF and hx of hyponatraemia)
Convulsions (serious cases. So caution in epilepsy)
Abdominal pain, N & V
Headache
Weight gain
Which alpha blocker is used for urinary retention in men?
Note: used in over 65s
Alfuzosin MR (10mg daily)
