Incontinence Flashcards
1
Q
Symptoms of stress incontinence
A
- Leaking of urine with inc abdominal pressure- coughing, laughing, sneezing
- Inc abdo pressure, no inc in detrusor activity
2
Q
Urge incontinence/ OAB symptoms
A
- Urgency +/- incontinence
- Freq
- Nocturia
Due to detrusor overactivity
3
Q
Red flag symptoms ?cancer
A
- Unexplained heamaturia
- Wt loss
- > 60yo, microscopic heamaturia and raised WCC
4
Q
Investigations
A
- Assess pelvic floor muscles
- Urine test for UTI
- Bladder scan for residual vol, if >100ml abnormal
- Bladder diary
5
Q
Urodynamics- when to perform
A
- Urge or mixed UI where type is unclear
- Before surgery for any UI
- Symptoms of voiding dys
- Ant or apical prolapse
- Prev surgery
6
Q
Mx of UI
A
- Lifestyle changes- less caffeine, stop drinking at 6pm, wt loss
- Supervised pelvic floor physio
- Bladder re-training
7
Q
Neurostimulation - PTNS
A
- Has to have MDT discussion
- Other methods to treat overactive bladder have not worked
- Pt does not want botox
8
Q
Long term catheters- intermittent or suprapubic
A
- If retention is causing incontinence
- Symptomatic infections
- Renal dysfunction
9
Q
Local MDT discussion if
A
- Surgery for stress UI, prolapse or overactive bladder
10
Q
Regional MDT if
A
- Repeat continence surgery
- Repeat prolapse
- Bowel and bladder issues
- Mesh complications
- Want surgery but want kids in the future
11
Q
Surgery for stress UI
A
- Lap colposuspension (gold stan)- Attach vaginal wall to IP ligament
- Autologous rectus fascial sling
- 2nd line- Bulking agents
- Mesh- needs careful discussion
12
Q
Risks of colposuspension
A
- Enterocele
- Voiding diff
- OAB
- Dyspareunia
- Bladder injury suture migration
13
Q
Medication for SUI - not 1st line
A
- Duloxetine 40mg BD
- Inc stimulation of sphincter
- ++ SE
- Avoid w SSRI, epilepsy, hepatic impairment
14
Q
Medications for OAB/UUI
A
- 1st line- Oxybutynin- not for elderly>80- affects mental health
- Tolterodine- BD dose, causes dry mouth
- Darifenacin/solifenacin- Good for elderly w dementia, (all anti ch)
- Desmopressin- good for nocturia, caution in >65/HTN.
- Transdermal rx if unable to tolerate oral.
- Mirabegron (B3 adrenoceptor agonist, has cardiac effects)- not first line, to rx urgency, inc freq and OAB.
15
Q
Contraindication for anti cholinergics
A
- Glaucoma
- Myasthenia gravis
- Ulcerative colitis
- Intestinal obstruction
