Female Urinary Incontinence Flashcards
What is the bladder nerve supply?
Storage - hypogastric nerve
Voiding - pelvic nerve (parasympathetic)
Voluntary - pudendal nerve
Describe cortical activity on bladder filling
Activates sympathetic pathway and reciprocal inhibition of parasympathetic
Mediates contraction of bladder base and proximal urethra
What is cortical influence on bladder emptying?
Activation of parasympathetic pathway and inhibition of sympathetic pathway
What are the different types of urinary incontinence?
Any involuntary leakage of urine
Stress - on effort or exertion
Urge - accompanied or preceded by urgency
Mixed - combination of all
What are the risk factors for urinary incontinence?
Age, parity, menopause, smoking, medical problems, increased abdo pressure, pelvic floor trauma, denervation, connective tissue disease and surgery
What is the main risk factor for urinary incontinence?
Pregnancy and childbirth
What are some irritation symptoms?
Urgency, increased daytime frequency, nocturia, dysuria and hamaturia
What are some incontinence symptoms?
Stress, urgency, coital incontinence and severity - pads a day
What is assessed in a patient presenting with urinary incontinence?
Irritancy and incontinence symptoms
Voiding symptoms
Fluid intake
Effect on QoL
Prolapse and bowel symptoms
What urinary tests are done for incontinence?
3 day urinary diary
Urine dipstick
What examinations are done for women with bladder/ pelvic floor problems?
General, abdominal, neurological, gynaecological and pelvic floor assessment
What investigations are done for urinary incontinence?
Urinalysis - multistix and possible MSSU
Post voiding residual volume assessment
Urodynamics - only if surgery indicated
What are the types of management for urinary incontinence?
Lifestyle changes, medical treatments, physiotherapy and surgery
Describe stress urinary incontinence
Intra-abdominal pressure exceeds urethral pressure
Pressure is increased by pelvic floor muscle training, surgery and pharmacological agents
What are the lifestyle changes for urinary incontinence?
Stop smoking, lose weight, eat more healthy to avoid constipation and stop drinking alcohol and caffeine
What is pelvic floor muscle training more effective than?
Than no treatment, electrical stimulation and vaginal cones
60-70% cure/ significant improvement
What pharmacological agent is used for moderate to severe stress urinary incontinence?
Yentreve - Duloxetine
Restricted use
Who should receive Duloxetine?
Primary care - if PFMT has failed or will be advanced with it
Secondary - do not wish surgery or not fit, failed surgery and when patient’s family is not complete
What is the anatomical defect in stress and urge incontinence?
Arises from defect in the anterior vaginal wall and pubo-urethral ligament
What is the integral theory of female UI?
Anatomical defect in anterior vaginal wall and pubo-urethral ligament in stress and urge
Sub-urethral hammock laxity might result in stimulation of bladder neck stretch receptors - premature micturation reflex
Describe mid-urethral slings and retro-pubic TVT
Tension free vaginal tape (TVT) - minimally invasive procedure to reinforce structures supporting the urethra
80% cure at 11 year follow up
Polypropylene permanent synthetic tape
Describe TVT vs colposuspesion
TVT is as effective as colposuspension for treatment of primary USI up to 2 years
Less operative and postoperative morbidity
What are the complications for TVT?
Bladder perforation
Vaginal and urethral erosions
Vascular injuries
Describe overactive bladder syndrome
Symptom complex usually but not always related to urodynamically demonstrable detrusor overactivity
What are the defining symptoms for overactive bladder syndrome?
Urgency (with or without urgency incontinence), usually with frequency and nocturia
What are the risk factors for urge incontinence?
Advanced age, diabetes, UTIs and smoking
OAB is chronic condition therefore symptoms may wax and wane
Describe the prevalence of OAB syndrome
Increases with age in males and females
Over 60 - higher in men
Under 60 - higher in females
What is the management for OAB?
Treat symptoms, no immediate care, MDT and requires dedicated approach
What lifestyle interventions can be done for OAB?
Normalise fluid intake, reduce caffeine, fizzy drinks, chocolate, stops smoking and weight loss
What is bladder training programme?
Times voiding with gradually increasing intervals - continence nurse
What is the pharmacological treatment for OAB?
Antimuscarinic - oral (Solifenacin, fesoteridine, trospium chloride, darifencain, lyrinel and oxybutinin)
Transdermal - Kentera patched
Tri-cyclic antidepressants - imipramine
What are recent advances in OAB treatment?
Botox and neuromodulation
