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Urology > Incontinence > Flashcards

Incontinence Flashcards

1
Q

what is the normal micturition reflex?

A
  • Stretch receptors (sensory fibre in pelvic nerve) sense bladder is half full and send signals to both sacral spinal cord S2-4/micturition centre and the brain pons
  • Spinal cord increases the parasympathetic stimulation (parasympathetic preganglionic motor fibre in pelvic nerve) and decreases sympathetic muscle – detrusor muscle contracts and internal sphincter relaxes.
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2
Q

what are the types of incontinence?

A
  • Stress
  • Urge
  • Overflow
  • Mixed – combo of urge and stress
  • Functional
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3
Q

what are the risk factors to developing incontinence?

A
  • Advancing age
  • Previous pregnancy and childbirth
  • High body mass index
  • Hysterectomy
  • Family history
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4
Q

what are the initial investigations for incontinence?

A
  • bladder diaries should be completed for a minimum of 3 days
  • vaginal examination
  • urine dipstick and culture
  • urodynamic studies
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5
Q

what is the cause of urge incontinence?

A

Detrusor Instability – inflammation/infection

Brain damage – stroke, Parkinson’s, dementia

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6
Q

what is the cause of stress incontinence?

A

Age and obesity
Pregnancy, childbirth, menopause
Post-surgery
Chronic cough

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7
Q

what is the cause of overflow incontinence?

A

Blockage – BPH, prostatic cancer, urethra narrowing, kidney stones
Ineffective detrusor muscle
Medication s/e – Ca Blockers, a-agonist, anti-psychotics/depressants
Surgery – proctectomy, hysterectomy

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8
Q

what is the pathophysiology of urge incontinence?

A

over reactive bladder, or Detrusor overactivity

Involuntary contractions of the detrusor muscle.

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9
Q

what is the pathophysiology of stress incontinence?

A

Incompetent sphincter or impaired pelvic floor

Increased abdominal pressure that overwhelms sphincter muscle causing urine to leak out – without activation of detrusor

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10
Q

what is the pathophysiology of overflow incontinence?

A

Bladder fills up and leaks through sphincter

caused by problems with emptying

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11
Q

what are the clinical features of urge incontinence?

A 
Sudden urge to urinate followed by involuntary urination
Daytime + night time frequency 
Small voided volume
Provocation – water 
Enuresis, frequent
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12
Q

what are the clinical features of stress incontinence?

A

Loss of small but frequent amounts of urine in response to precipitating factors – cough, sneeze, laugh

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13
Q

what are the clinical features of overflow incontinence?

A 
Weak/intermittent stream
Hesitancy 
Palpable bladder
Wet at night 
Post micturition dribble differential
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14
Q

how is urge incontinence diagnosed?

A

Urodynamics + culture

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15
Q

how is stress incontinence diagnosed?

A

Urodynamics + culture

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16
Q

how is overflow incontinence diagnosed?

A

Cytometry

17
Q

how is urge incontinence managed?

A 
Decrease muscle activity
Avoid caffeine/alcohol
Bladder retraining
Antimuscarinics – oxybutynin, tolterodine, darifenacin 
Beta-3 agonist – mirabegron
Botox injection
Enterocystoplasty
18
Q

how is stress incontinence managed?

A

Pelvic floor exercises
Lose weight, reduce alcohol, caffeine, smoking
Duloxetine (SNRI)
Norepinephrine (NE)
Surgery – sling procedure, tension-free vaginal tape, coloposuspension

19
Q

how is overflow incontinence managed?

A 
Assess renal function
Treat the obstruction 
Consider alpha-blocker for prostatic enlargement
CATHETERISATION – IV fluids
Rehabilitate the bladder
20
Q

what are the causes of overactive bladder?

A
  • Multi-factorial/unknown
  • Catheter-related irritation
  • Risk Factors: obesity, caffeine, constipation, diabetes, poor functional motility, chronic pelvic pain
21
Q

what is the underlying mechanism of overactive bladder?

A

Overactivity of detrusor muscle

22
Q

what are the clinical features of overactive bladder?

A

urgency, urinary frequency, nocturia, urge incontinence (not in dry classification)

23
Q

how is overactive bladder diagnosed?

A
  • History
  • Urine culture to rule out UTI
  • Urodynamics not usually needed
24
Q

what is the lifestyle management for overactive bladder?

A

fluid restriction, avoid caffeine, bladder retraining, PFM exercise

25
Q

what is the medical management for overactive bladder?

A

o Antimuscarinic Drugs = darifenacin, hyoscyamine, oxybutynin, tolterodine, solifenacin, trospium, fesoterodine
o B3 Adrenergic Receptor agonists – mirabegron

26
Q

what is the procedural management of overactive bladder?

A

urgetn PC neuromodulation, botox, electrical stimulation

Urology (10 decks)

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