Incontinence and urinary retention

Question 1

What is cystometry and what is it used for & how?

Answer 1

• It measures the pressure-volume relationships of the bladder. This means the measurement of detrusor pressure during controlled bladder filling and subsequent voiding with measurement of synchronous flow rate
• It helps characterise detrusor function by assessing:
  1. Bladder compliance
  2. Sensation
  3. Stability and capacity
• How?
  1. Place catheters in the bladder (to find total bladder pressure) and the rectum (to measure intra-abdominal pressure)

2. Subtract abdominal pressure from total bladder pressure to find intrinsic pressure of the bladder

CONTRACTION OF BLADDER = increased pressure = flow of urine

Question 2

Aetiology of urinary incontinence & types exprienced by men and women.

Answer 2

• It is a storage symptom, the complaint of any involuntary loss of urine
• Weakness of the urinary outlet in value - urodynamic stress incontinence
• Failure of the bladder to store urine due to high bladder pressure - urge incontinence
• Combination of weakness of the urinary outlet and failure of the bladder to store urine - mixed incontinence
• A bladder that is overfull and overflows (chronic retention) - overflow incontinence
• Abnormal communications of the urinary tract e.g. fistula
• MEN: Overactive bladder, neuropathic bladder, prostatectomy, overflow incontinence
• WOMEN: Stress, urge, overflow, mixed

Question 3

Risk factors and management of incontinence

Answer 3

• Risk factors:
  1. Pregnancy and childbirth
  2. Age / menopause
  3. Obesity
  4. Constipation
  5. Pelvic organ prolapse
  6. Chronic cough/smoking
  7. Excessive weight lifting / high impact aerobics
• Management:
  1. Lifestyle changes e.g decrease caffeine intake
  2. Behavioural therapy - pelvic floor exercises, vaginal weights
  3. Pharmacologic agents: alpha-adrenergic agonists, oestrogen, tricyclic antidepressants
  4. Surgical treatment - elevation or support of bladder neck, enhance urethral resistance (reinforce sphincter), or combination of the two