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Reproductive > Female urinary incontinence > Flashcards

Female urinary incontinence Flashcards

1
Q

What does the urinary tract consist of?

A

2 mutually dependent components:

  • Upper tract = kidneys and ureters
  • Lower tract = bladder and urethra
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2
Q

What is the role of the upper tract of the urinary system?

A

Low pressure distensible conduit with intrinsic peristalsis

Transports urine from nephrons via ureters to bladder

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3
Q

What is the role of the lower tract of the urinary system?

A

Low-pressure storage of urine

Efficient expulsion of urine

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4
Q

What rate does the bladder fill at?

A

0.5-5mls/min

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5
Q

What is the vesico-ureteric mechanism?

A

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

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6
Q

What nerves supply the bladder?

A 
Hypogastric nerve (sympathetic T10-L2)
Pelvic nerve (parasympathetic S2-4)
Pudendal nerve (somatic S2-4)
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7
Q

What does the hypogastric nerve (sympathetic T10-L2) supply and control?

A

Detrusor muscle

Storage - causes relaxation of the detrusor muscle, promoting urine retention

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8
Q

What does the pelvic nerve (parasympathetic S2-4) supply and control?

A

Detrusor muscle

Voiding - contraction of the detrusor muscle, stimulating micturition

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9
Q

What does the pudendal nerve (somatic S2-4) supply and control?

A

External urethral sphincter

Innervates the external urethral sphincter, providing voluntary control over micturition

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10
Q

What does cortical activity control in regards to the bladder?

A

Increases sphincter contraction and activity
Activates sympathetic pathway & reciprocal inhibition of the parasympathetic pathway
Mediates contraction of bladder base and proximal urethra

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11
Q

In simple terms, does sympathetic innervation aid voiding or storage?

A

Storage

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12
Q

In simple terms, does parasympathetic innervation aid voiding or storage?

A

Voiding

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13
Q

What physiologically happens during bladder emptying?

A

Detrusor contraction
Urethral relaxation
Sphincter co-ordination

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14
Q

Where is the cortical activity in the brain helping with micturition?

A

Pontine micturition centre

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15
Q

What does the pontine micturition centre control in terms of voiding?

A

Activation of parasympathetic pathway

Inhibition of sympathetic pathway

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16
Q

What is mixed urinary incontinence (UUI)?

A

Involuntary leakage accompanied by or immediately preceded by urgency & on effort or exertion, sneezing or coughing

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17
Q

How is the prevalence of UI affected with age?

A

Increases with age

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18
Q

What impact does UI have on life?

A 
Impair QoL
Reduce social relationships/activities
Impair emotional/psychological well being
Impair sexual relationships
Embarrassment/self-esteem
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19
Q

What are risk factors for UI?

A 
Age
Parity
Menopause
Smoking
Increased intraabdo pressure
Pelvic floor trauma
Denervation
Connective tissue disease
Surgery
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20
Q

What is the main risk factor for stress incontinence?

A

Pregnancy & childbirth

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21
Q

What might you ask in patient Hx of UI?

A

Age, parity, mode of deliveries, weight of heaviest baby, smoking, HRT
Medical conditions: DM, anti-HTN medications, glaucome, cognitive problems, anti-depressants/anti-psychotics
Previous PFMT, surgical treatment of SUI or POP

22
Q

What are irritation symptoms?

A 
Urgency
Increased daytime frequency
Nocturia
Dysuria
Haematuria
23
Q

What are voiding symptoms?

A

Straining to void
Interrupted flow
Recurrent UTI

24
Q

What is OAB (overactive bladder) usually associated with?

A

Frequency
Nocturia
Urgency

25
Q

What are prolapse symptoms?

A

Vaginal lump

Dragging sensation in vagina

26
Q

What are bowel problems associated with UI?

A

Anal incontinence
Constipation
Faecal evacuation dysfunction
IBS

27
Q

What can be assessed in patients with UI?

A

3 days urinary diary: fluid intake, urine output, daytime freq, nocturia, average voided volume
Urine dipstick

28
Q

What should be examined in a woman with bladder/pelvic floor problems?

A 
General
Abdominal
Neurological
Gynaecological
Pelvic floor assessment
29
Q

What is the scale for assessing pelvic floor?

A

Oxford Scale

30
Q

What are you looking for in an examintion in a woman with bladder/pelvic floor problems?

A 
Prolapse
SI
Uro-genital atrophy changes
Pelvic mass (space occupying lesion)
Pelvic floor tone, strength, awareness
31
Q

What are investigations for urinary incontinence?

A

Urinalysis: Dipstix +/- MSSU
Post voiding residual volume assessment
Urodynamics

32
Q

When is urodynamic studies indicated?

A

If surgical treatment contemplated

33
Q

What is the management for UI?

A

Lifestyle changes
Medical treatments
Physio
Surgery

34
Q

What lifestyle changes can be made for UI?

A

Stop smoking
Lose weight
Eat healthier to avoid constipation
Stop alcohol and caffeine

35
Q

What does pelvic floor muscle training do?

A

Reinforcement of cortical awareness of muscle groups
Hypertrophy of existing muscle fibres
General increase in muscle tone and strength

36
Q

What drug for moderate to severe stress UI (SUI)?

A

Duloxetine

37
Q

What should Duloxetine be prescribed with?

A

Pelvic floor muscle training (PFMT)

38
Q

Who should receive Duloxetine?

A

PFMT failed or would be enhanced with Duloxetine

Or if no surgery in secondary care

39
Q

What is the theory related to SUI and the mechanism of continence at the time of increased intra-abdominal pressure?

A

Pressure-Transmission Theory

40
Q

Where is the anatomical defect in both SUI and UUI?

A

Anterior vaginal wall and pubo-urethral ligament (PUL)

41
Q

What anatomical feature might provoke a a premature micturition reflex and UI?

A

Suburethral hammock laxity resulting in stimulation of bladder neck stretch receptors

42
Q

What are surgical treatments for UI?

A

TVT - tension-free vaginal tape

Colposuspension

43
Q

What happens in surgery with tension-free vaginal tape (TVT)?

A

Minimally invasive procedure to reinforce the structures supporting the urethra

44
Q

What is the first choice treatment in the surgical treatment of SUI?

A

TVT

45
Q

What is overactive bladder syndrome?

A

Symptom related to urodynamically demonstrable detrusor overactivity (DO)

46
Q

What are the symptoms of overactive bladder?

A

Urgency (with/without UI)
Frequency
Nocturia

47
Q

What are risk factors for urge incontinence?

A

Advanced age
Diabetes
UTIs
Smoking

48
Q

What type of condition is OAB?

A

Chronic - symptoms may wax and wain

49
Q

What is the management for OAB?

A

Treat symptoms
No immediate cure
MDT approach
Lifestyle: normalise fluid intake, reduce caffeine, chocolate, stop smoking, weight loss
Bladder training programs: timed voiding gradually increasing intervals

50
Q

What is the pharmacological treatment for OAB?

A

Antimuscarinics: solifenacin
Tri-cyclic antidepressants: imipramine
Botox
Neuromodulation

Reproductive (20 decks)

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