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Kidney function and failure > Incontinence and retention > Flashcards

Incontinence and retention Flashcards

1
Q

Female urinary bladder can store:

A

350 ml

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2
Q

Male urinary bladder can store:

A

450 ml

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3
Q

Histology of urinary bladder:

A

Outer adventitial layer: connective tissue
Middle smooth muscle: detrusor muscle
Inner: transitional epithelium

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4
Q

Mictuition is controlled by:

A

Pontine micution center

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5
Q

The sympathetic nervous system acts to:

A

Retain urine: relax detrusor, contract internal sphincter

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6
Q

The parasympathetic nervous system acts to:

A

Urinate: contract detrusor

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7
Q

Nerves involved in mictuition:

A
  • Pelvic afferent (sensory)
  • Pelvic nerve (PS)
  • Hypogastric (S)
  • Pudendal (Somatic)
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8
Q

Receptors involved in mictuition:

A

M3, B3, a1, nicotinic

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9
Q

External urethral spincter is:

A

Skeletal muscle, under voluntary control

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10
Q

Pelvic and pudendal nerves come from which level of the spinal cord?

A

S2-S4

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11
Q

Test to look at problems filling and emptying bladder:

A

Cystometry

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12
Q

Cystometry measures pressures in what:

A
  • Rectum
  • Bladder
  • Intrinsic bladder pressure (bladder - rectum)
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13
Q

Pressure measurements are measured in synchronicity with:

A

Flow rate

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14
Q

BPH =

A

Benign prostatic hypertrophy

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15
Q

BOO =

A

Bladder outflow obstruction

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16
Q

Types of male lower urinary tract symptoms:

A
  • Voiding

- Storage

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17
Q

Voiding symptoms:

A 
Weak, intermittent stream
Staining
Hesitancy
Incomplete emptying
Terminal dribble
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18
Q

Storage symptoms:

A
  • Frequency
  • Urgency
  • Nocturia
  • Incontinence
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19
Q

What is common in men but uncommon in women?

A

Voiding difficulty

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20
Q

Causes of voiding difficulty:

A

Increased outflow resistance from obstruction at bladder neck or prostate
Detrusor muscle failure (less likely)

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21
Q

Detrusor muscle failure can be primary or secondary to…

A

Bladder outflow obstruction

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22
Q

What hormone is though to be involved in cell hypertrophy of prostate?

A

Dihydrotestosterone

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23
Q

5 a reductase =

A

Converts testosterone into DHT

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24
Q

What may you see on cystometry of BPH:

A

Pressure double and only manages to pass half the flow

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25
Q

Acute urinary retention =

A

Painful inability to void with relief of pain following bladder drainage

26
Q

Diagnosis of urinary retention:

A

volumes between 500-800 ccs

27
Q

BOO and retention in women in:

A

Rare, usually has a urogenic cause

28
Q

Zones of the prostate:

A

Peripheral, central, transitional

29
Q

Complications of BPH:

A 
Obstruction - retention
Overflow incontinence
Bladder stones
Kidney damage
Increased risk of infection
30
Q

Causes of retention:

A
  • Urethral obstruction

- Neurological

31
Q

Treatment of retention

A

Intermitted self-catheterisation
In-dwelling catheter
Alpha blockers, phytotherpay

32
Q

Phytotherapy =

A

Use of plant-derived medications in treatment

33
Q

Alduzosin hydrocholrise, dozazosin, tamsulosin, prazosin :

A

Alpha blockers

34
Q

MoA of Tamsulosin:

A

Blocks alpha receptor on sphincter - relaxes sphincter

35
Q

Ex of 5ARI:

A

Finasteride

36
Q

Alpha blockers work to:

A
  • Improve symptoms
37
Q

4ARIS work to:

A

Reduce symptoms and prevent progression

38
Q

Onset of symptoms relief with BPH meds:

A

1-2 weeks with alpha blockers, longer with 5ARIs

39
Q

TUIP =

A

Transurethral incision of prostate

40
Q

TURP =

A

Transurethral resection of prostate

41
Q

What should you consider in any patient presenting with voiding difficulty, particularly those with incontinence

A

Detrusor failure or underactive detrusor function. Incontinence may be overflow.

42
Q

Incontinence =

A

A storage symptom. Any involuntary loss of urine

43
Q

2 ways incontinence can be an issue:

A
  • Social

- Hygiene

44
Q

Types of incontinence:

A

Stress
Urge
Overflow
Mixed

45
Q

Stress incontinence =

A

Leakage of urine due to extra abdominal pressure (coughing, sneezing, laughing). Usually due to problem with sphincter.

46
Q

Urge incontinence =

A

Sudden urge and intense need to pass urine. Usually due to bladder spasms

47
Q

Mixed incontinence =

A

Stress and urge

48
Q

Overflow incontinence =

A

Due to chronic retention

49
Q

Incontinence is common in:

A
  • Women
  • Hospital
  • Nursing homes
50
Q

UI QoL issues

A

Distress, embarrassment, inconvenience, hygiene, self-esteem

falls, fractures, depression, increased likelihood of institutionalisation

51
Q

Risk factors for UI:

A
  • Pregnancy, childbirth
  • Obesity
  • Age, menopause
  • Constipation
  • Chronic cough, smoking
52
Q

Treatment of stress incontinence:

A
  • Pelvic floow exercises
  • a-adrenergic agonists
  • oestrogens
  • tricyclic antidepressants
  • surgery
53
Q

Surgical treatments for stress incontinence:

A
  • Elevation or support of bladder neck: TVT, TVT-O, TOT, SIMUS
  • Enhance urethral resistance: bulking agents (e.g. collagen)
54
Q

TVT =

A

Tension free vaginal tape

55
Q

TVT-O =

A

Tension free vaginal tape oburator

56
Q

TOT =

A

Transobturator tape

57
Q

SIMUS =

A

Single incision mid urethral tape

58
Q

Treatment of overactive bladder/urge incontinence:

A
  • Behavioural therapy, relaxation
  • Anticholinergics
  • Botox
  • Surgery
59
Q

Anti-cholinergics:

A

Oxybutynin, tolterodine

60
Q

Surgery for overactive bladder:

A

Sacral nerve stimulation

PTNS = percutanous posterior tibial nerve stimulation

Kidney function and failure (9 decks)

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