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Year 3: Reproduction > Female urinary incontinence > Flashcards

Female urinary incontinence Flashcards

1
Q

What is the upper urinary tract?

- pressure is?

A

kidneys and ureter

  • low pressure distensible conduit with intrinsic peristalsis
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2
Q

what does the UUT DO?

A

Transport urine from nephrons via ureters to the bladder.

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3
Q

What is the lower urinary tract?

A

Bladder & Urethra

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4
Q

rate of bladder filling is?

- storage of urine pressure is?

A
  1. 5-5 mls/min

- low

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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 the bladder

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6
Q

nerve supply to the bladder?

  • for storage
  • voiding
  • voluntary
A

pelvic nerves
- hypogastric nerve (sympathetic T10-L2)

  • pelvic nerve - parasympathetic S2-4
  • pudendal nerve - S2-S4 - voluntary
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7
Q

bladder filling - what does it have to do?

A

Accommodate increasing volume at constantly low pressure.

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8
Q

cortical activity means what in terms of bladder filling ? (3)

A

Activating a reciprocal guarding reflex

  • Rhabdosphincter contraction
  • increase sphincter contraction & resistance.
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9
Q

Cortical activity activates and mediates what 3 things?

A
  • Activates Sympathetic pathway &
  • Reciprocal inhibition of the Parasympathetic pathway
  • Mediates contraction of bladder base and proximal urethra
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10
Q

Bladder emptying is due to what contraction and what relaxation?

  • needs co-ordination of what?
  • needs the absence of?
A
  • Detrusor
  • Urethral
  • Sphincter
  • Obstruction or anatomical shunts (Cystocele, Diverticulum)
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11
Q

what is the cortical influence off bladder emptying (pathways affected)? - what micturition centre is it?

A
  • Pontine

- Activation of parasympathetic pathway & Inhibition of Sympathetic pathway

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12
Q

what % of women between age 15-60 report UI?

A

10-25%

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13
Q

what are the impacts of UI?

A
  • impair the QoL.
  • Reduce social relationships and activities.
  • Impair emotional and psychological well- being.
  • Impair sexual relationships.
  • Embarrassment and diminished self- esteem.
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14
Q

Risk factors of UI?

A 
Age
Parity
Menopause
Smoking
Medical problems
Inc Intra abdo pressure
Pelvic floor trauma
Denervation
Connective tissue disease
Surgery
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15
Q

what is the main risk factor for SI?

A

Pregnancy & Childbirth

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16
Q

What are crucial history questions to ask a female presenting with UI?

A

Age, parity, mode of deliveries, weight of heaviest baby, Smoking, HRT,

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17
Q

Medical conditions to ask about in UI history?

A

DM, anti-HTN medications, Glaucoma, Heart/Kidney/Liver problems, Cognitive problems, Anti-depressants/ anti-psychotics.

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18
Q

what may be irritation symptoms someone presents with?

A

Urgency ; Sudden compelling desire to void that is difficult to defer.

  • Increased daytime frequency (>7)
  • Nocturia (>1)
  • Dysuria
  • Haematuria ☻
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19
Q

what is urgency usually associated with? (5)

A

with frequency, nocturia and urgency incontinence

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20
Q

what are incontinence symptoms? (4)

A
  • Stress UI
  • Urgency UI
  • Coital Incontinence
  • Severity: How many pads/ day?
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21
Q

what are voiding symptoms?

A

Straining to void
Interrupted flow
Recurrent UTI ☻

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22
Q

scale of how much Urinary leakage affects day to day activities

A

0 -10

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23
Q

what are prolapse symptoms (3)

A

Vaginal Lump/ Dragging sensation in vagina

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24
Q

what are bowel symptoms? (4)

A

Anal Incontinence, Constipation, faecal evacuation dysfunction, IBS.

25
Q

patient assessment - feature (5)

- test u may do?

A
  • Fluid intake: Quantity & Quality
  • Urine Out-Put (exclude Nocturnal Polyuria)
  • Daytime Frequency,
  • Nocturia
  • Average voided volume.

urine dipstick

26
Q

Examination of the women with Bladder/ Pelvic floor problems (5 types)

A
  • General
  • Abdominal
  • Neurological
  • Gynaecological
  • Pelvic floor assessment (Oxford Scale)
27
Q

Examination of the women with bladder/ pelvic floor problems - what are you looking for?

A
  • Prolapse
  • Stress incontinence
  • Uro-genital atrophy changes
  • Pelvic mass (space occupying leasion)
  • Pelvic floor tone, strength, awareness
28
Q

Investigations you can carry out?

A
  • Urinalysis: Multistix +/- MSSU
  • Post voiding residual volume assessment (usually by bladder scanning) only If symptoms of voiding difficulties.
  • Urodynamics: ONLY indicated if surgical treatment is contemplated.
29
Q

Management of UI?

A
  • Lifestyle changes - stop smoking, weight loss, eat healthy to avoid constipation, avoid caffeine and alcohol
  • Medical treatments
  • Physiotherapy
  • Surgery
30
Q

When does stress urinary incontinence occur?

A

intra-abdominal pressure exceeds urethral pressure, resulting in leakage

31
Q

urethral closure pressure is increased by? (3)

A
  • pelvic floor muscle training
  • surgery
  • pharmacological agents
32
Q

Why should you carry out pelvic floor muscle training?

A
  • reinforcement of cortical awareness of muscle groups
  • hypertrophy of existing muscle fibres
  • general increase in muscle tone and strength
33
Q

what is the only drug licensed for severe stress incontinence?

A

duloxetine

34
Q

who should receive duloxetine

A

if PMFT has failed

  • they do not want surgery
  • failed surgery
  • not fit for surgery
35
Q

why do stress and urge incontinence arise?

A

anatomical defect in the anterior vaginal wall & pubo-urethral ligament (PUL).

  • Urethral/bladder neck closure dysfunction and USI
36
Q

what laxity might result in stimulation of bladder neck stretch receptors?

  • what may this provoke?
A

Suburethral Hammock

  • a premature micturition reflex and Urgency Incontinence
37
Q

what is a minimally invasive procedure used to reinforce the structures supporting the urethra?

A

Tension-free vaginal tape (TVT)

38
Q

what is the only drug licensed for severe stress incontinence?

A

duloxetine

39
Q

who should receive duloxetine

A

if PMFT has failed

  • they do not want surgery
  • failed surgery
  • not fit for surgery
40
Q

why do stress and urge incontinence arise?

A

anatomical defect in the anterior vaginal wall & pubo-urethral ligament (PUL).

  • Urethral/bladder neck closure dysfunction and USI
41
Q

what laxity might result in stimulation of bladder neck stretch receptors?

  • what may this provoke?
A

Suburethral Hammock

  • a premature micturition reflex and Urgency Incontinence
42
Q

TVT Vs Colposuspension

A

TVT is as effective as Colposuspension for the treatment of primary USI up to 2 years.

43
Q

First choice treatment for SUI?

A

TVT

44
Q

What is Overactive Bladder Syndrome (ICS Definition)?

A

symptom complex usually, but not always, related to urodynamically demonstrable detrusor overactivity (DO)

45
Q

defining symptoms

A

urgency (with/without urgency incontinence), usually with frequency and nocturia

46
Q

what is urge incontinence?

A

The complaint of involuntary leakage of urine accompanied or immediately preceded by urgency

47
Q

Describe what DO is like?

A

involuntary detrusor contractions during filling

  • spontaneous or provoked
  • neurogenic when there is a relevant neurologic condition or idiopathic when there is no defined cause
48
Q

prevalence of OAB?

A

increases with age, and is slightly higher in women

49
Q

Risk Factors for Urge Incontinence? (4)

A
  • Advanced age
  • Diabetes
  • Urinary tract infections
  • Smoking
50
Q

OAB is a..?

A

chronic condition

51
Q

what is nocturia?

A

Usually accompanies urgency with or without urge incontinence and is the complaint that the individual has to wake at night one or more times to void

52
Q

OAB conservative management - lifestyle interventions

A
  • Normalise fluid intake
  • Reduce caffeine, Fizzy drinks, Chocolate
  • Stop Smoking
  • Weight loss
53
Q

what is a bladder training programme?

A

Timed voiding with gradually increasing intervals - Continence nurse

54
Q

what treatment is used for OAB?

A

Antimuscarinic

55
Q

Oral treatment options for OAB?

A 
Solifenacin (Vesicare 5-10mg ) 
Fesoteridine (Toviaz 4-8 mg)
Trospium Chloride (60mg XL)
Darifencain (Emselex 7.5-15 mg ) – Constipation; FI
Lyrinel XL (10-20 mg ) 
Oxybutinin (5-10 mg/ tds)
56
Q

Transdermal treatement for OAB?

A

Kentera Patches

57
Q

Tri-cyclic antidepressants for OAB include?

A

Imipramine

58
Q

anticholinergic agents currently used In the UK for OAB?

A

atropine, propantheline,

trospium chloride, and propiverine, a calcium antagonist and anticholinergic

59
Q

Recent advances - drugs and methods for OAB? 2 TYPES - what are they and what do they do

A 
Botulinum Toxin  (A&B)
NDO/ IDO
  • Neuromodulation
    Needle stimulation (S2-4)
    Reflex Inhibition to the Detrusor muscle

Year 3: Reproduction (40 decks)

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