deck_1556098 Flashcards
What are the main types of urinary incontinence?
Stress urinary incontinenceUrge urinary incontinenceMixed urinary incontinenceOverflow urinary incontinence
Why does urinary incontinence occur?
It occurs when the bladder pressure is greater than the urethral sphincter pressure. Either due to:– detrusor pressure is high– sphincter pressure is low
What is a major factor which helps to maintain continence?
Strength and support of the urethra by the pelvic floor muscles and ligaments.
What is urinary incontinence?
The complaint of involuntary leakage of urine. – has a massive impact on quality of life
Describe stress urinary incontinence
the complaint of involuntary leakage on effort or exertion, or on sneezing or coughing
Describe urge urinary incontinence
the complaint of involuntary leakage (of urine) accompanied by or immediately proceeded by urgency
Describe mixed urinary incontinece
the complaint of involuntary leakage (of urine) associated with urgency and also with exertion, effort, sneezing or coughing
Describe overflow incontinence
Retention of urine causing the bladder to swell. Can be low pressure and pain free.
What are some risk factors for incontinence?
Pregnancy and childbirthAnatomical abnormalitiesObesityAgeIncreased intra-abdominal pressureUTIMenopauseDrugs– anything that weakens the pelvic floor muscles
What is the most common form of incontinence?
- Stress urinary incontinence2. Mixed urinary incontinence3. Urge urinary incontinence
What is the correlations of age and the incidence of incontinence?
Incidence steadily increases with age
What should you find out from the patient’s history?
– Record amount of fluid passed over 2-3 days (helps for categorisation, determine if intermittent or continuous)– Previous surgery on plelvic floor– Childbirth
What else can cause an increase in frequency of urination?
Intravesicular inflammatory conditionUrinary tract infectionStone in the bladderTumour
What would you typically do for an examination for paitents you suspect have incontinence?
Height and weightAbdominal examinationDigital rectal examination– prostate exam in malesFemales– external genitalia– vaginal exam
What are some typical investigations?
Urine dipstickBasic, non-invasive urodynamics– frequency-vol chart– bladder diary for about 3 days– post-micturition residual volume for patients with voiding dysfunction
What are some other investigations that are not always necessary?
Invasive urodynamics - pressure flow studiesPad testCytoscopy
Describe what pressure flow studies measure
Measure abdominal pressureMeasure internal bladder pressureMeasure detrusor pressure (ab pressure minus internal bladder pressure)
Give some methods of conservative management
Change fluid intakeLose weightStop smokingDecrease caffeine and fizzy drinks intakeAvoid constipationTimed voiding, have a fixed schedule
What is contained incontinence?
Patients who are not suitable for surgery and who have failed conservative or medical management.
Give some examples of contained incontinence
–Indwelling catheter, wither urethral or suprapubic– Sheath device (adhesive condom attached to catheter tubing and bag)– Incontinence pads
What is a specific treatment for stress urinary incontinence?
Pelvic floor muscle training
What is a specific treatment for urge urinary incontinence?
Bladder training such as having a schedule of voiding
Describe bladder training
Void every hour Must not void in betweenIncrease times between voiding until up to 2-3 hoursUndertake for 6 weeks
Describe some pharmacological treatments
Duloxetine– NA and serotonin uptake inhibitor. Increases activity of external urethral sphincter during filling phase. Is an alternative to surgery and not used a s a first choice. Anticholinergics– Act on M2 and M3 receptors to reduce contraction of detrusor muscle. Botulinum toxin– Inhibits ACh at pre-synaptic neuromuscular junction causing targeted flaccid paralysis–Lasts for 3-6 months
What are the main permanent surgical interventions for women?
Low tension vaginal tapesOpen retropubic suspension procedureClassic fascial sling procedure
Describe low-tension vaginal tapes
Most commonSupport the mid urethra with polypropylene meshIs >90% successful
Describe the open retropubic suspension procedure
Correct anatomical position of the proximal urethra and improves urethral supprt
Describe the classic fascial sling procedure
Supports urethra and increases bladder outflow resistance. Involved autologous transplantation of the fascia lata or rectus fascia
What is a surgical procedure for women which is used for temporary relief of symptoms?
Intramural bulking agents– improve ability of urethra to resist abdominal pressure – Inject autologous fat, silicone, collagen or hyaluron-dextran polymers
What are the surgical procedures which are used in males?
Artificical urinary sphincterMale sling procedure
Describe the artificial urinary sphincter surgery
Cuff is a mechanical device which stimulate the action of a normal sphincter to close the urethra. – can have problem with infection, erosion and device failure.
Describe the male sling procedure
Corrects iatrogenic caused incontinence. Uses a bone-anchored tape in order to support the urethra.
What is the normal capacity of the bladder?
300 - 700 ml– can be more in different people
