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Repro - Gynae > Incontinence > Flashcards

Incontinence Flashcards

1
Q

somatic control of weeing

A

by pudendal nerve (S2-4) - ACh on a nicotinic receptor making your eus contract

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2
Q

parasympathetic control of weeing

A

pelvic nerve (S2-4) - ACh on a muscarinic receptor making you detrusor muscles contract

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3
Q

sympathetic control of weeing

A 
hypogastric nerve (T10-L2) - NA on alpha receptor making your ius contract
NA on beta receptor making you detrusor relax
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4
Q

ACh acts on which receptor types

A

nicotinic and muscarinic

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5
Q

NA/A act on which receptors types

A

alpha and beta

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6
Q

what type of incontinence results from a weak bladder outlet

A

stress incontinence

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7
Q

what type of incontinence is due to a weak pelvic floor and so is common in parous women

A

stress

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8
Q

treatment of stress incontinence

A

PFMT, oestrogen cream, duloxetine and surgery

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9
Q

how is duloxetine used to manage stress incontinence

A

used in moderate or severe incontinence as part of a strategy including PFMT

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10
Q

two types of surgery for stress incontinence

A

culposuspension and TVT (tension-free vaginal tape)

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11
Q

by what theory does culposuspension and TVT work in incontinence

A

hammock theory - by having the bladder lying low it may stimulate bladder neck receptors to prematurely micturate

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12
Q

what two types of incontinence is culposuspension and TVT used in

A

urge and stress

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13
Q

what is the problem in urge incontinence

A

bladder contracts too readily with a small volume and involuntarily

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14
Q

what proportion of women in nursing homes are incontinent

A

50%

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15
Q

investigations of incontinence

A 
3 days urinary diary
urine dipstick
post voiding residual volume assessment
urodynamics (uroflowmetry)
cystometry
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16
Q

4 lifestyle changes to improve stress incontinence

A

stop smoking
lose weight
eat better to avoid constipation
stop drinking alcohol and caffeine

17
Q

how does TVT work

A

bit of tape goes around the urethra and attaches to the front of the abdoominal wall

18
Q

true/false TVT has higher operative and postoperative morbidity than colposuspension

A

false - less morbidity is associated

19
Q

what is the 1st line surgical treatment

A

TVT

20
Q

true/false - TVT can be curative

A

true - in 80% of cases

21
Q

common complications of TVT

A

bladder perforation

vaginal and urethral erosions

22
Q

what surgery option has a lower morbidity than TVT

A

TOT - has a comparable success rate too

23
Q

what is overactive bladder syndrome

A

urge incontinence - urodynamically demonstrable detrusor overactivity

24
Q

symptoms of overactive bladder syndrome

A

urgency +/- incontinence with frequency and nocturia

25
Q

risk factors for urge incontinence

A

older
diabetic
UTI
smoker

26
Q

what age group is overactive bladder syndrome most common in

A

75+

27
Q

4 lifestyle modifications for OAB syndrome

A

regular fluid intake
reduce caffeine
stop smoking
lose weigth

28
Q

conservative management of OAB syndrome

A

bladder training programme and lifestyle modification

29
Q

pharmacological treatment of OAB syndorme

A

antimuscarinics and TCAs

30
Q

how does an antimuscarinic work in treating OAB syndrome

A

blocks ACh action at muscarinic receptor on detrusor muscle and so inhibits its contraction

31
Q

what drugs can be usd to treat BPH in male outflow obstruction

A

alpha blocker and anti-androgens

32
Q

what incontinence is commonly secondary to catheterisation, MS and stroke

A

neuropathic bladder (too weak)

33
Q

how do you treat a neuropathic bladder

A

catheterisation

34
Q

what other class of drug can be used to treat OAB syndrome

A

beta-3-adrenoceptor agonists

35
Q

two types of receptor on detrusor muscle

A

beta and muscarinic

36
Q

what can be injected to treat OAB syndrome

A

botox bby

Repro - Gynae (6 decks)

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