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Renal > Incontinence > Flashcards

Incontinence Flashcards

1
Q

What is stress incontinence

A

Leaking of urine on effort or exertion - e.g. sneezing

Common in women

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2
Q

What is urge urinary incontinence

A

Leakage accompanied by or immediately preceded by urgency.

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3
Q

What causes urge urinary incontinence

A

Bladder overactivity - detrusor instability

Can be due to pathology that irritates the bladder

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4
Q

What causes stress incontinence

A

Caused by bladder neck/urethral hypermobility and/or neuromuscular defects leading to sphincter deficiency
Weak pelvic floor

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5
Q

What is mixed urinary incontinence

A

Combination of stress and urge incontinence

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6
Q

What does bed wetting indicate

A

High-pressure chronic urinary retention

Common in elderly men

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7
Q

What causes post-micturition dribbling

A

This occurs in men immediately after leaving the toilet

Caused by urine pooling in the bulbar urethra

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8
Q

What is overflow incontinence

A

Seen in those with chronic retention

Urine is release unintentionally as bladder cannot hold it

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9
Q

What does a continuous flow of urine suggest

A

Fistula between the urethra and vagina or an ectopic ureter (seen in young girls

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10
Q

Is incontinence more common in women or men

A

Women

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11
Q

List risk factors for incontinence

A 
Genetic predisposition 
Neurological disorder - stroke, cord injury
Anatomical abnormality - fistula, diverticulum etc 
Childbirth 
Pelvic, perineal and prostate surgery 
Radiotherapy 
Diabetes  
Smoking - coughing
UTI 
Oestrogen deficiency 
Cognitive defect 
Increased fluids
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12
Q

What are the red flag urinary symptoms

A 
Pain 
Haematuria 
Recurrent UTI 
Voiding/obstructive symptoms 
Mass 
Neurological deficit 
History of pelvic surgery/radiotherapy
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13
Q

List some investigations for incontinence

A 
Keep a bladder diary 
Urinalysis and culture 
Flow rate and post-void residue 
Pad testing 
Blood tests 
Scans
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14
Q

Give examples of conservative treatments for incontinence

A

Pelvic floor exercise - good for stress
Lifestyle - weight loss, smoking, modify fluid intake, reduce alcohol and coffee
Bladder training

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15
Q

Which medications are available for treating incontinence

A

Duloxetine - increases sphincter muscle activity by inhibiting reuptake of adrenaline and serotonin

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16
Q

Which surgical treatments are available for incontinence

A

Injections of bulking agents into the bladder neck to improve sphincter seal
Retropubic suspension
Sub urethral tapes and sling - supports the bladder more
Artificial urinary sphincter

17
Q

Describe retropubic suspension

A

Elevate and fix the bladder in a retropubic position so that the neck is better supported

18
Q

How do artificial urinary sphincters work

A

Inflatable cuff is placed around bulbar urethra or bladder neck
A pressure regulating balloon is placed in the abdomen
An activating pump is put in the scrotum or labia majora

Pump is squeezed which transfers fluid to the balloon and the cuff deflates allowing voiding

19
Q

What conservative treatments are available for overactive bladders

A 
Pelvic floor exercise 
Biofeedback 
Acupuncture 
Electrical stimulation therapy
Modify fluid intake, avoid caffeine and alcohol 
Bladder training
20
Q

which medication can be used for an overactive bladder

A

Anticholinergics - inhibit contractions and increase bladder capacity
E.g. oxybutynin
B3 adrenoreceptor agonists - mirabegron

21
Q

How can botox be used in incontinence

A

In overactive bladders you can inject under the mucosa or into the detrusor
Abolishes unstable contraction by partially paralysing the detrusor
Repeated 3-4 times a year

22
Q

What is neuromodulation

A

Use a device to stimulate the sacral nerves (S3) which inhibits detrusor activity
Test percutaneously first and if successful a device can be implanted

23
Q

What is a ‘clam’ ileocystoplasty

A

Operation where the bladder is opened and a section of ileum is attached to create a larger bladder volume
Used in urge incontinence and intractable frequency

24
Q

what is a ileal conduit urinary diversion

A

Ureters are anastomosed and connected to a small length of ileum which is brought out in a stoma

For intractable cases only

Renal (18 decks)

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