Genitourinary

Question 1

What is urgency incontinence

Answer 1

sudden immediate need to pee that is difficult to delay

Question 2

What is stress incontinence

Answer 2

leakage on effort or exertion, or on sneezing or coughing

Question 3

What is mixed incontinence

Answer 3

urgency and stress, however one type usually predominates

Question 4

Risk factors of urinary incontinence

Answer 4

old age, pregnancy and vaginal delivery, obesity, smoking, constipation, family history, medicines (diuretics, alcohol, caffeine)

Question 5

Non drug treatment for urinary incontinence

Answer 5

modify fluid intake, weight loss, reduce caffeine

Question 6

urgency incontinence treatment

Answer 6

1. bladder training for at least 6 weeks
2. antimuscarinic (oxybutynin or tolterodine)
3. mirabegron

Question 7

stress incontinence treatment

Answer 7

pelvic floor for at least 3 months, surgery or duloxetine

Question 8

Mixed incontinence treatment

Answer 8

bladder training > 6 weeks and pelvic floor > 3 months
treat pharmacologically in accordance to dominating type

Question 9

Name antimuscarinics

Answer 9

fesoterodine, solifenacin, trospium, oxybutynin, tolterodine

Question 10

antimuscarinics side effects

Answer 10

constipation, dry mouth, flushing, dizziness, drowsiness, tachycardia, drowsy (affects skilled tasks/driving)

Question 11

antimuscarinics contra-indications

Answer 11

angle-closure glaucoma and GI obstruction

Question 12

What is nocturnal enuresis

Answer 12

involuntary urination during sleep
common in children

Question 13

nocturnal enuresis non drug treatment step 1

Answer 13

under 5 yrs old
protective bedding, resolve on own
advice = no fluids 4 hours before sleep, diet, toileting behaviour, reward system

Question 14

nocturnal enuresis non drug treatment step 2

Answer 14

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

Question 15

Nocturnal enuresis non drug treatment step 3

Answer 15

if 1 and 2 unsuccessful add in desmopressin

Question 16

nocturnal enuresis drug treatment

Answer 16

> 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repeated courses withdrawn gradually at regular intervals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

Question 17

Desmopressin

Answer 17

more potent and longer duration of action than vasopressin
no vasoconstrictor effect
side effects = hyponatraemia = convulsions if given rapidly, nausea

Question 18

what is urinary retention

Answer 18

inability to voluntarily urinate

Question 19

causes of urinary retention

Answer 19

urethral blockage, medications (antimuscarinics, sympathomimetics, TCAs)

Question 20

Acute urinary retention

Answer 20

is a medical emergency
abrupt development over a period of hours

Question 21

Chronic urinary retention

Answer 21

gradual over months
inability to completely empty bladder

Question 22

what is benign prostatic hyperplasia

Answer 22

type of chronic urinary retention caused by enlarged prostate
symptoms = urinary retention, urgency, frequency, nocturne
tx = a-blockers (relaxes smooth muscle)

Question 23

Acute urinary retention treatment

Answer 23

catheter then a-blocker for 2+ days before removing catheter

Question 24

Chronic urinary retention treatment

Answer 24

catheter long term - may cause recurrent UTIs (7 days abx), urethra trauma, pain, stone formation

Question 25

BPH treatment

Answer 25

a-blocker (relaxes smooth muscle) if enlarged prostate, increased prostate antigens, or at high risk of progression then 5a reductase inhibitor (finasteride/dutasteride)

Question 26

Name a-blockers

Answer 26

alfuzosin, tamsulosin, doxazosin, terazosin

Question 27

a-blockers contra indications

Answer 27

micturition syncope, postural hypotension

Question 28

a-blockers side effects

Answer 28

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

Question 29

Name 5a reductase inhibitors

Answer 29

Finasteride, dutasteride

Question 30

5a reductase inhibitors side effects

Answer 30

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

Question 31

Finasteride MHRA Warning

Answer 31

depression and rare cases of suicidal thoughts - stop immediately and inform healthcare professional

Question 32

What is erectile dysfunction

Answer 32

persistant inability to attain/maintain erection

Question 33

Causes of erectile dysfunction

Answer 33

physical, psychological or side effect of drugs

Question 34

Erectile dysfunction non drug treatment

Answer 34

smoking cessation and reduce alcohol intake

Question 35

Erectile dysfunction 1st line drug treatment

Answer 35

- 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

Question 36

Erectile dysfunction 2nd line drug treatment

Answer 36

intracavernasal, intraurethral, or topical alprostadil - under careful medical supervision

Question 37

Phosphodiesterase type 5 inhibitors side effects

Answer 37

- flushing, dizziness, nasal congestion, migraine - priapism (erection>4 hours) = medical attention

Question 38

Phosphodiesterase type 5 inhibitors contra indications

Answer 38

- taking nitrates - have hypotension - unstable angina/stroke - angina during intercourse - people who shouldn't have sexual activity

Question 39

Phosphodiesterase type 5 inhibitors interactions

Answer 39

- nitrates - a-blockers - both cause hypotension

Question 40

Alprosadil warning

Answer 40

wear condom if partner of child bearing age, pregnant or lactating