Bladder: Urinary Incontinence, Retention Flashcards
Risk factors for urinary incontinence
Age
Pregnancy and childbirth Hx
High BMI
Pelvic surgery - hysterectomy
FHx
Types of incontinence
Overactive bladder/urge
-detrusor overactivity
-sudden urge => uncontrollable leaks
Stress
-small amount leaks when coughing/lacughing
Mixed
Overflow
-due to bladder outlet obstruction
Initial investigations for incontinence
Bladder diary - 3 days minimum
Vaginal exam
-pelvic organ prolapse
-ability to contract pelvic floor
Urinedip, culture
Urodynamic studies
Incontinence management depending on the type
Urge
-bladder retraining
-bladder stabilising meds
Incontinence management depending on the type
-stress
Stress - pelvic floor training
-8 contractions 3x a day for 3 months
If needed => surgery
-retropubic mid-urethral tape procedure
Duloxetine if surgery declined
-increased stimulation of urethral sphincter muscles
Acute urinary retention
-risk factors
-presentation
More common in older men
Causes
-Most common - BPH
-urethral stricture
-stones
Medication
-anticholinergics
-TCAs
-antihistamines
-opioids, BZ
UTIs
Subacute onset of
-inability to pass urine
-lower abdo discomfort/pain/tenderness
-palpable distended bladder
-acute confusional state if older
Can also present with overflow incontinence
Acute urinary retention
-investigations
Rectal exam
Neuro exam
Pelvic exam
Urinalysis and culture
FBC, CRP - infection
U&E - AKI
Confirm diagnosis - bladder scan (300ml+)
-but can still diagnose if Hx and examination are indicative and scan isn’t
Acute urinary retention
-management
Immediate
Catheter - decompress bladder
Assess volume drained in 15mins
-U200 => not AUR
-400+ => keep catheter in
-inbetween volumes => case dependent
Definitive - treat underlying cause
TWOC
-if they reenter retention => recatheterise and try again later
-multiple failed attempts => long term catheter until definitive management made
Complications of resolution of retention through catheterisation
-who is at risk
Post-obstructive diuresis => volume depletion and worsen AKI
-IV fluids may be needed to correct this
Patients with high post-void volumes
Chronic urinary retention
-presentation
-causes
-investigations
-management
Painless, insidious
-significant bladder distention => desensitization
-voiding LUTS
BPH
Pelvic prolapse/mass
Neuro - peripheral neuropathy, UMN disease (MS, PD)
High pressure retention - pressure overcomes antireflux mechanism of bladder and ureters
-impaired renal function
-bilateral hydronephrosis
Low pressure retention - reduced detrusor contractility
-normal renal function
-no hydronephrosis
FBC, CRP - infection
U&E - renal function
Kidney US - hydronephrosis
Catheterise
High pressure retention - long term catheter
-intermittent self catherisation is an option if LTC not wanted
-requires patients to do this at regular intervals, requires manual dexterity and patient compliance
Manage underlying cause
Complications of chronic retention
UTI
Stones
High pressure retention => AKI, CKD
