Bladder + Urinary disorders, Bladder instillations and urological surgery

Question 1

what is the first line for urge incontinence?

Answer 1

Antimuscarinics
-oxybutynin (direct relaxant on urinary muscles; available as transdermal patch)
-tolterodine
-fesoterodine
-darifenacin
-solifenacin
-flavoxate
-propantheline bromide
-propiverine
-trospium

Question 2

what is the second line agent for urge incontinence?

Answer 2

-Beta3 agonist
-mirabegron (caution: QT interval prolongation. Contraindicated in severe uncontrolled hypertension

Question 3

what is used for management of stress incontinence?

Answer 3

duloxetine- avoid abrupt withdrawal

Question 4

What is first line treatment in children for nocturnal enuresis?

Answer 4

-enuresis alarms
-continue until 2 weeks of uninterrupted dry nights

Question 5

what is second line for nocturnal enuresis in children?

Answer 5

-desmopressin in 5+ years
-USE: sublingual or oral. Not to give intrasally for nocturnal enuresis due to increased sid eeffects

Question 6

what are some side effects of desmopressins? +counseliing

Answer 6

hyponatraemic convulsions
-avoid fluid overload )including during swimming, restrict fluid intake 1 hr before and until 8 hours after
-stop if vomiting/diarrhoea until normal fluid balance. Avoid concomitantt drugs that increase vasopressin secretion e.g. tricyclic antidepressants

Question 7

what are some alpha-blockers that can relax prostatic smooth muscles?

Answer 7

terazosin
doxazosin
indoramin
alfuzosin
tamsulosin

Question 8

what are some side effects of alpha-blockers?

Answer 8

-hypotension, notably postural hypotension (dizziness, fainting, blurred vision, tachycardia, palpitations)

Question 9

what are some contraindications for alpha-blockers? +counselling

Answer 9

postural hypotension
-take first dose at bedtime as risk of first dose postural hypotension
-driving can be impaired

Question 10

what is finasteride which is a 5alpha-reductase inhibitor mian side effects? +counselling

Answer 10

-male breast cancer:report breast symptoms e.g. lumps, nipple discharge, pain
-depression and suicidal thoughts: stop and report

Question 11

what is the advice for women using finasteride?

Answer 11

-use condoms if partner or likely to get pregnant, as its excreted in semen
-women of child bearing age; avoid handling crushed finasteride tablets and leaking dutasteride capsules