Genitourinary Flashcards
What is urgency incontinence
sudden immediate need to pee that is difficult to delay
What is stress incontinence
leakage on effort or exertion, or on sneezing or coughing
What is mixed incontinence
urgency and stress, however one type usually predominates
Risk factors of urinary incontinence
old age, pregnancy and vaginal delivery, obesity, smoking, constipation, family history, medicines (diuretics, alcohol, caffeine)
Non drug treatment for urinary incontinence
modify fluid intake, weight loss, reduce caffeine
urgency incontinence treatment
- bladder training for at least 6 weeks
- antimuscarinic (oxybutynin or tolterodine)
- mirabegron
stress incontinence treatment
pelvic floor for at least 3 months, surgery or duloxetine
Mixed incontinence treatment
bladder training > 6 weeks and pelvic floor > 3 months
treat pharmacologically in accordance to dominating type
Name antimuscarinics
fesoterodine, solifenacin, trospium, oxybutynin, tolterodine
antimuscarinics side effects
constipation, dry mouth, flushing, dizziness, drowsiness, tachycardia, drowsy (affects skilled tasks/driving)
antimuscarinics contra-indications
angle-closure glaucoma and GI obstruction
What is nocturnal enuresis
involuntary urination during sleep
common in children
nocturnal enuresis non drug treatment step 1
under 5 yrs old
protective bedding, resolve on own
advice = no fluids 4 hours before sleep, diet, toileting behaviour, reward system
nocturnal enuresis non drug treatment step 2
if 1 unresponsive (> 1- 2 bed wets per week) = enuresis alarm
alarms in < 7 yrs depending on maturity, motivation and understanding
less relapse than drug tx when discontinued
r/v alarm after 4 weeks
continue until min 2 wks of uninterrupted dry nights
Nocturnal enuresis non drug treatment step 3
if 1 and 2 unsuccessful add in desmopressin
nocturnal enuresis drug treatment
> 5 yrs = desmopressin:
if alarm undesirable
if need rapid results (to cover holidays)
assess tx after 4 wks and =continue for 3 months if working
repeated courses withdrawn gradually at regular intervals
specialist = desmopressin +/- antimuscarinic (oxybutynin or tolterodine)
not responding to all other tx = imipramine
Desmopressin
more potent and longer duration of action than vasopressin
no vasoconstrictor effect
side effects = hyponatraemia = convulsions if given rapidly, nausea
what is urinary retention
inability to voluntarily urinate
causes of urinary retention
urethral blockage, medications (antimuscarinics, sympathomimetics, TCAs)
Acute urinary retention
is a medical emergency
abrupt development over a period of hours
Chronic urinary retention
gradual over months
inability to completely empty bladder
what is benign prostatic hyperplasia
type of chronic urinary retention caused by enlarged prostate
symptoms = urinary retention, urgency, frequency, nocturne
tx = a-blockers (relaxes smooth muscle)
Acute urinary retention treatment
catheter then a-blocker for 2+ days before removing catheter
Chronic urinary retention treatment
catheter long term - may cause recurrent UTIs (7 days abx), urethra trauma, pain, stone formation
BPH treatment
a-blocker (relaxes smooth muscle)
if enlarged prostate, increased prostate antigens, or at high risk of progression then 5a reductase inhibitor (finasteride/dutasteride)
Name a-blockers
alfuzosin, tamsulosin, doxazosin, terazosin
a-blockers contra indications
micturition syncope, postural hypotension
a-blockers side effects
dizziness, postural hypotension
take first dose at night as may cause collapse due to postural hypotension. Lie down if fatigue, dizzy, sweating until feel better
Name 5a reductase inhibitors
Finasteride, dutasteride
5a reductase inhibitors side effects
breast disorder, sexual dysfunction, male breast cancer - report lumps/pain/nipple discharge, excreted in semen
use condom if partner preg/likely to be preg
women of child bearing age = avoid handling crushed/broken tablets
Finasteride MHRA Warning
depression and rare cases of suicidal thoughts - stop immediately and inform healthcare professional
What is erectile dysfunction
persistant inability to attain/maintain erection
Causes of erectile dysfunction
physical, psychological or side effect of drugs
Erectile dysfunction non drug treatment
smoking cessation and reduce alcohol intake
Erectile dysfunction 1st line drug treatment
- phosphodiesterase type 5 inhibitor
- increase blood flow intake to penis - still need sexual stimulation
- short acting - avanafil, sildenafil, vardenafil - PRN
- long acting - tadalafil - PRN or lower dose daily for spontaneous
- 6 doses at max dose with stimulation before classed as non-responder
Erectile dysfunction 2nd line drug treatment
intracavernasal, intraurethral, or topical alprostadil - under careful medical supervision
Phosphodiesterase type 5 inhibitors side effects
- flushing, dizziness, nasal congestion, migraine
- priapism (erection>4 hours) = medical attention
Phosphodiesterase type 5 inhibitors contra indications
- taking nitrates
- have hypotension
- unstable angina/stroke
- angina during intercourse
- people who shouldn’t have sexual activity
Phosphodiesterase type 5 inhibitors interactions
- nitrates
- a-blockers
- both cause hypotension
Alprosadil warning
wear condom if partner of child bearing age, pregnant or lactating
