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Reproduction Pathology > Female urinary incontinence > Flashcards

Female urinary incontinence Flashcards

1
Q

Upper tract of urinary tract involves

A

kidneys

ureters

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2
Q

Lower tract of urinary tract involves

A

bladder

urethra

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3
Q

Definition of the upper tract of the urinary tract

A

Low pressure distensible conduit with intrinsic peristalsis which transports urine from nephrons to the bladder

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4
Q

Rate of bladder filling

A

0.5-5mls/min

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5
Q

Function of lower tract of urinary tract

A

low pressure storage of urine

efficient expulsion of urine at an appropriate place and time

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6
Q

Function of vesico-ureteric mechanism

A

Protects the nephrons from any damage to secondary to retrograde transmission of back pressure or infection of the bladder

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7
Q

Nerves that supply the storage function of the bladder

A

Hypogastric nerve (sympathetic) T10-L2

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8
Q

Nerves that supply the voiding function of the bladder

A

pelvic nerve (parasympathetic) S2-4

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9
Q

Nerves that supply the voluntary aspect of the bladder

A

Pudendal nerve (somatic) S2-4

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10
Q

How does the bladder empty?

A
  1. detrusor contraction
  2. urethral relaxation
  3. sphincter contraction
  4. cortical influence (pontine micturition centre)
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11
Q

What happens from the cortical influence (pontine micturition centre) in the emptying of the bladder?

A

Activation of parasympathetic pathway and inhibition of sympathetic pathway

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12
Q

Types of urinary incontinence

A

Urinary incontinence
Stress urinary incontinence
Urge urinary incontinence / Overactive bladder
Mixed urinary incontinence

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13
Q

Definition of urinary incontinence

A

ANY involuntary leakage of urine

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14
Q

Definition of stress urinary incontinence

A

Involuntary leakage on effort of exertion, on sneezing or coughing. Intraabdominal pressure exceeds the urethral pressure, resulting in leakage

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15
Q

Definition of urge incontinence

A

Involuntary leakage accompanied by or immediately preceded by urgency

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16
Q

Definition of mixed incontinence

A

Involuntary leakage of urine accompanied by or immediately preceded by urgency and on effort or exertion, or on sneezing or coughing

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17
Q

Prevalence of urinary incontinence increases with….

A

Age

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18
Q

Impact of urinary incontinence

A

May significantly impact QoL
Reduce social relationships and activities
Impair emotional and psychological well being
Impair sexual relationships
Embarrassment and diminished self esteem

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19
Q

Pathology of stress and urge incontinence

A

Anatomical defect in the anterior vaginal wall and pubo-urethral ligament -> urethral/bladder neck closure dysfunction and USI

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20
Q

Risk factors for urinary incontinence

A 
age
parity
menopause
smoking
medical problems
increased intraabdominal pressure
pelvic floor trauma 
denervation 
connective tissue disease 
surgery 
pregnancy and childbirth
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21
Q

Main risk factor for stress incontinence

A

Pregnancy and childbirth

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22
Q

Symptoms of urinary incontinence

A

Irritation symptoms

  • urgency
    • sudden compelling desire to void that is difficult to defer
    • increased daytime frequency (>7)
    • nocturia (>1)
    • dysuria
    • haematuria
    • urgency usually associated with frequency, nocturia, and urgency
  • Incontinence
    • stress UI
    • urgency UI
    • coital incontinence
    • severities pads/day
  • voiding
    • straining to void
    • interrupted flow
    • recurrent UTI
  • Prolapse symptoms
    • vaginal lump
    • dragging sensation in vagina
  • Bowel symptoms
    • anal incontinence
    • constipation
    • faecal evacuation dysfunction
    • IBS
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23
Q

Investigations for urinary incontinence

A 
History and examination 
3 day urinary diary 
Effect on QoL
Urinary dipstick 
Urinalysis (multistix +/- MSSU)
Post voiding residual voiding assessment 
Urodynamics
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24
Q

When is the investigation of urodynamics ONLY indicated?

A

if surgical treatment is implicated

25
Q

Urodynamics involves…

A

Uroflytometery

Multi-channel cystometry

26
Q

Treatment of urinary incontinence

A
  1. Nothing
  2. Conservative
  3. Physiotherapy - PFMT for stress UI, bladder retraining for urgency UI
  4. Yentreve (Duloxetine) or antimuscarinics
  5. Surgery
27
Q

In the treatment of urinary incontinence, when is Duloxetine used?

A 
If PFMT failed or would be enhanced by 
Does not wish surgery 
Not fit enough for surgery 
After failed surgery 
When patients family are not complete
28
Q

Definition of Overactive Bladder Syndrome (OBS)

A

A symptom complex (symptom syndrome) usually related to urodynamically demonstrable detrusor overactivity (DO) but may also be due to other uterovesical dysfunction

29
Q

Who does overactive bladder syndrome affect?

A

Both sexes

All ages

30
Q

Types of detrusor overactivity in overactive bladder syndrome

A

neurogenic (relevant neurological condition)

Idiopathic

31
Q

Defining symptoms of overactive bladder syndrome

A

Urgency +/- urgency incontinence
Frequency
Nocturia

32
Q

Definition of urge

A

The complaint of a sudden, compelling desire to pass urine that is difficult to defer

33
Q

Definition of urge incontinence

A

The complaint of involuntary leakage accompanied or immediately preceded by urgency

34
Q

Definition of frequency

A

The complaint by the patient who considers they void too often by the day, usually accompanies urgency +/- urge UI

35
Q

Definition of nocturia

A

The complaint that the individual has to wake at night one or more times to void, usually accompanying urgency +/- urge incontinece

36
Q

Risk factors for urge incontinence

A

Advanced age
Diabetes
UTI
Smoking

37
Q

Treatment for overactive bladder syndrome

A 
Lifestyle interventions
- normalise fluid intake 
- reduce caffeine, fizzy drinks 
- stop smoking
- weight loss
Bladder training programme 
Antimuscarinics 
Tri-cyclic antidepressants 
Botox 
Neuromodulation
38
Q

What are the 3 stages of urgency incontinence?

A

Mild
- can keep it
- do not have to stop conversation to go to the toilet
Moderate
- Have to stop the conversation as cannot wait to go to the toilet
Severe
- Has to go to the toilet right away otherwise will have an accident

39
Q

How many women > 40 y/o have Urinary incontinence?

A

30 - 40%

40
Q

How many women < 24 y/o have urinary incontinence?

A

12 - 14%

41
Q

What is the most common type of urinary incontinence?

A

Stress UI

42
Q

% of people who get each type of UI

A

Stress - 43%
Urgency / OAB - 21%
Mixed - 35%

43
Q

Pathology of an overactive bladder

A

The bladder is contracting too much due to activity from nerves and the micturition centre

44
Q

Pathology of stress incontinence

A

Problem with the pelvic floor - weak levator ani muscles
Cannot control urethra properly
Increased IAP

45
Q

What does IAP stand for?

A

Intra abdominal pressure

46
Q

What fruits in particular can make you go to the toilet?

A

Citrus fruits

47
Q

Describe bladder retraining

A

Hold urine for 2 hours then go
Increase the time in between each time you go until up to 4 hours
This impulses the brain not to contract every time that the patient needs to go

48
Q

What surgery can be done for stress UI?

A

Colposuspension

MUS (tapes)

49
Q

What does MUS stand for?

A

Mid urethral slings

50
Q

Which of the treatments for SUI is very invasive?

A

Colposuspension

51
Q

What surgery can be done for urgency UI?

A

Botox injection every 6 - 9 months
- into detrusor muscle so it does not contract
- however self catheterisation required every 3 - 4 hours
Sacral nerve modulation
- Use tibial nerve to stimulate nerves around the bladder
- not commonly used

52
Q

1st line treatment for urge incontinence

A

Bladder retraining

53
Q

1st line treatment for stress incontinence

A

PFMT

54
Q

Give an example of an antimuscarinic

A

Oxybutylin

55
Q

On urodynamics, what does a high voiding detrusor pressure and a low peak flow rate indicative of?

A

Bladder outflow obstruction

56
Q

What would indicate a vesicovaginal fistula?

A

Patients with continuous dribbling in continence after prolonged labour and from a country with poor obstetric services

57
Q

Investigation of vesicovaginal fistula

A

Urinary dye studies

58
Q

What is the investigation of choice in incontinence where the diagnosis is uncertain or there is plans for surgery?

A

Urodynamic studies

Reproduction Pathology (28 decks)

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