Bladder Problems Flashcards
What are the causes of stress urinary incontinence (UI)?
Weakness of the pelvic floor:
- post partum
- constipation (recurrent straining)
- obesity
- post menopausal
- pelvic surgery e.g. TURP (damaging external sphincter)
What are the causes of urge UI?
Overactive bladder (detrusor hyperactivity):
- neurogenic e.g. previous stroke
- infection
- malignancy
- idiopathic
- medication .e.g. cholinesterase inhibitors
What are the causes of overflow incontinence?
Chronic urinary retention –> loss of bladder sensation
- prostatic hyperplasia (most common)
- spinal cord injury
- congenital defects
Which investigations should be done for patients with UI?
Initially:
- midstream urine dipstick
- post void bladder scans
If conservative management fails or uncertain aetiology:
- urodynamic testing (detrusor hyperactivity)
- outflow urodynamics (detrusor muscle activity against flow rate)
Which lifestyle advice should be given to patients with incontinence?
Weight loss
Reduce caffeine
Smoking cessation
Avoid drinking excessive fluid volumes
What is the conservative management for stress incontinence?
Pelvic floor muscle training for at least 3 months
If no improvement –> trial of DULOXETINE
What is the conservative management for urge incontinence?
Anti-muscarinics (inhibit detrusor)
–> oxybutinin or tolterodine
Bladder training for at least 6 weeks
What are the surgical options for stress incontinence in conservative management fails?
Tension-free vaginal tape
Open colposuspension (elevation of bladder neck and urethra)
Intamural bulking agents
Artificial urinary sphincter
What are the surgical options for urge incontinence if conservative management fails?
Botox injections
Percutaneous sacral nerve stimulation
Augmentation cystoplasty
Urinary diversion via ileal conduit
What is the most common type of bladder cancer?
Transitional cell carcinoma
What are the risk factors for bladder cancer?
Smoking Increasing age Aeromatic hydrocarbons (industrial dyes or rubbers) Schistosomiasis infection Previous radiation to pelvis
Which kind of cancer does schistosomiasis predispose to?
Squamous cell carcinoma
What are the clinical features of bladder cancer?
Painless haematuria
Recurrent UTIs or lower urinary tract symptoms
Ureteric obstruction of cancer blocks ureteric orifice
If locally advanced –> pelvic pain
If metastasised –> weight loss/lethargy
How is suspected bladder cancer investigated?
Urgent flexible cystoscopy under local anaesthetic
If suspicious lesion seen –> do a rigid cystoscopy under GA + biopsy tumour
CT for TNM staging
What is the management for non-muscle-invasive bladder cancer?
Carcinoma in situ or T1 tumours:
–> resected via TURBT either during initial rigid cystoscopy or after biopsy results
High rate of recurrence –> regular surveillance
