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Year 3 Repro (JK) > Female urinary incontinence > Flashcards

Female urinary incontinence Flashcards

1
Q

Upper urinary tract

A

kidney and ureter
low pressure distensible - intrinsic peristalsis
urine from nephrons to the ureters to bladder

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2
Q

Lower urinary tract

A

bladder and urethra

low pressure storage of urine

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3
Q

filling rate of bladder

A

0.5-5mls/min

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4
Q

function of vesico-ureteric mechanism

A

protect nephrons from retrograde transmission of back pressure or infection from the bladder

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5
Q

bladder nerve supply - storage

A

hypogastric T10-L2

sympathetic

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6
Q

bladder nerve supply - voiding

A

pelvic nerve S2-4

parasympathetic

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7
Q

bladder nerve supply - voluntary

A

pudendal nerve S2-4

somatic

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8
Q

Cortical activity function - bladder filling

A

increase sphincter contraction and resistance

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9
Q

how does cortical activity work in bladder filling

A

activate sympathetic pathway
reciprocal inhibition of the parasympathetic
contraction of bladder base and proximal urethra

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10
Q

Bladder emptying

A

detrusor contraction
urethral relaxation
sphincter co-ordination
absence of obstruction

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11
Q

Cortical influence in bladder emptying

A

pontine micturition centre

activate parasympathetic and inhibit sympathetic

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12
Q

Urinary incontinence

A

Any involuntary leakage of urine

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13
Q

stress UI

A

involuntary leakage on effort, sneezing, coughing etc

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14
Q

urge UI

A

involuntary leakage accompanied or preceded by urgency

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15
Q

Mixed UI

A

involuntary leakage accompanied or immediately preceded by urgency and on effort, sneezing etc

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16
Q

Epidemiology of incontinence

A

10-25% of 15-60
15-40% of over 60
>50% in nursing homes

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17
Q

Impact of UI

A 
QOL 
sexual life 
social activities 
psychological 
self esteem
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18
Q

Main risk factor for incontinence

A

parity and childbirth

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19
Q

Other risk factors for incontinence

A 
pelvic surgery 
age 
menopause 
smoking/alcohol 
medical 
increase intra abdominal pressure 
pelvic floor trauma
denervation 
connective tissue disease
20
Q

Incontinence - history

A
  1. age, parity, mode of deliveries, weight of heaviest baby, smoking, HRT
  2. medical conditions, DM, glaucoma, heart/kidney/liver
  3. previous PFMT, surgical treatment of SUI or POP
21
Q

Irritation symptoms

A

urgency, >7 day, nocturia, dysuria, haematuria

22
Q

incontinence symptoms

A

SUI, UUI, coital, severity - number of pads

23
Q

Voiding symptoms

A

straining, interrupted flow, recurrent UTI

24
Q

Prolapse symptoms

A

vaginal lump, dragging sensation

25
Q

Bowel symptoms - incontinence

A

IBS, constipation, anal incontinence

26
Q

3 days urine diary

A 
fluid intake - quantity and content 
urine output
daytime frequency 
nocturia 
average voidal volume
27
Q

Examination

A 
general eg BMI 
abdo - distention 
neurological - sacral lower limb
gynaecological 
pelvic floor assessment 
prolapse
SUI 
uro-genital atrophy 
pelvic mass 
pelvic floor, tone, strength, awareness
28
Q

Investigations

A

urinalysis
post voiding residual volume
urondynamics - uroflowmetry and cystometry

29
Q

4 broad management methods for incontinence

A

lifestyle changes
surgery
pharmacological
physio

30
Q

How to increase urethral closure pressure in SUI

A

PFMT
surgery
pharmacology

31
Q

lifestyle changes

A

stop smoking
lose weight
eat healthy
stop drinking alcohol

32
Q

PFMT - 3 basic principles of what it does

A

reinforce cortical awareness of muscle groups
hypertrophy of existing muscle groups
general increase in muscle tone and strength

33
Q

Pharmacological treatment for SUI

A

duloxetine

34
Q

Colposuspension

A

raise bladder neck - surgery

35
Q

Integral theory of female UI

A

both arise from problem with anterior vagina wall/pubo-urethral ligament
USI - urethral/bladder neck closure dysfunction
UUI - suburethral hammock laxity

36
Q

TVT function

A

reinforce structure supporting urethra

37
Q

First line for SUI surgery

A

TVT

38
Q

concerns over TVT

A

bladder perforation
vaginal and urethral erosions
several vascular injuries

39
Q

TOT side effect

A

thigh pain

40
Q

cause of OAB

A

detrusor overactivity

41
Q

OAB symptoms

A

urgency, frequency, nocturia, UUI

42
Q

urgency

A

complaint of sudden, compelling desire to pass urine

43
Q

OAB treatment

A

fluid intake, reduce caffeine, stop smoking, weight loss

bladder training programme

44
Q

Bladder retraining

A

re-establish cortical control over detrusor

timed bladder emptying programme

45
Q

pharmacological treatment of OAB

A

anti-muscarinic - oral or transdermal

tri cyclic antidepressants

46
Q

Recent advances in OAB treatment

A

botox

neuromodulation (S2-4)

Year 3 Repro (JK) (33 decks)

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