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Year 2 > Incontinence and Urinary Retention > Flashcards

Incontinence and Urinary Retention Flashcards

1
Q

What is the lower urinary tract?

A

Bladder and urethra which are responsible for storing urine and emptying

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2
Q

What is the structure of the urinary bladder?

A

3 layers
Innermost layer: transitional epithelia
Middle layer: Detrusor smooth muscle
Outermost layer: Adventitia connective tissue

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3
Q

What is voiding?

A

Urination

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4
Q

What is the neurological control of urination?

A

Pontine micrutition centre in the brainstem however there is central control. Involves co-ordination between smooth muscle of detrusor and urethra relaxation to leave no urine in the bladder

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5
Q

Effect of sympathetic system on the bladder?

A

Increases the bladder capacity of the detrusor muscle to enlarge without increasing pressure.

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6
Q

Effect of parasympathetic system on bladder?

A

Detrusor muscle contraction and causes the internal sphincter to relax.

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7
Q

How are male urethras affected by pathology?

A

Enlarged prostate increases urinary retention

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8
Q

What is the capacity of the bladder?

A

500ml

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9
Q

What are the sex differences in urination?

A

Women have a lower void of 30-40cm of H2O with a higher max flow rate than men.

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10
Q

What is cystometry?

A

Measure of detrusor muscle function via pressure-volume relationship. Assesses the pressure of the destrusor muscle in both controlled bladder filling and voiding compared to the synchronous flow-rate.

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11
Q

What is the role of cystometry?

A

Assess detrusor function for bladder compliance, sensation and stability and capacity.

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12
Q

What is bladder sensation?

A

Sensation transmitted via pressure and stretch receptors in the detrusor muscle walls that induces void desire.

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13
Q

What is bladder stability?

A

Contractions of the detrusor muscle.

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14
Q

What affects the bladder pressure?

A

Rectal pressure- high pressure may reduce bladder capacity or the bladder stability and result in urinary urgency. Rectal pressure must be substracted from detrusor muscle pressure to find the detrusor effect.

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15
Q

How is bladder pressure determined?

A

The abdominal pressure + the detrusor muscle pressure

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16
Q

LUTS

A

Lower Urinary tract symptom which affects primarily men over 65 years old

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17
Q

How is LUTS categorised?

A

Categorised into:
Storage
Voiding issues
Post-micrutition issues

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18
Q

What are the storage issues?

A

Includes:
Urgency
Frequency
Nocturia

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19
Q

What are the voiding issues?

A

Hesitancy: difficulty starting urination
Weak stream
Straining: required to empty bladder
Pain/discomfort
Incomplete emptying
Terminal dribbling

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20
Q

Why do voiding issues occur?

A

Commonly caused by increased outflow resistance at the bladder neck or urethra. There may be detrusor muscle failure.

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21
Q

What are the post-micrutition issues?

A

Dribbling

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22
Q

BPH

A

Benign prostactic hyperplasia- enlargement of the prostate due to increased number of cells

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23
Q

BPE

A

Benign prostatic enlargement- enlargement of prostate. In the early stages of urinary obstruction, increase in detrusor muscle pressure in voiding to compensate.

24
Q

BOO

A

Bladder outflow obstruction- occurs at the base of the bladder in the urethral opening that can occur due to BPE

25
Q

Cause of BOO in women

A

Neurological issue with the pontine micrutition centre or urethral obstruction. Generally rarer than in men

26
Q

How does BOO present in women?

A

Characteristic symptoms of acute urinary retention such as hesitancy, straining, incomplete sense of emptying

27
Q

How is BOO treated in women?

A

Catheterisation or with a catheratisable stoma

28
Q

What is acute urinary retention?

A

Painful inability to urinate, which is relieved following catheterisation with large volume of urine drained.

29
Q

What can be mistaken for acute urinary retention?

A

Acute surgical conditions that cause abdominal pain and fluid depletion

30
Q

How is AUR managed?

A

Phytotherapy: medicines from plants or herbs
Alpha blockers and 5-alpha reductase inhibitors to reduce bladder capacity

31
Q

5-alpha reductase inhibitors

A

Better for long term use by preventing symptomatic progression of acute urinary retention and provide imporvement in symptoms of flow.

32
Q

Detrusor failure

A

Reduced strength or duration of detrusor muscle contraction. This can occur due to lower motor neuron lesion affecting the bladder or prostate obstruction or urethral stricture

33
Q

What is urinary incontinence?

A

Storage issue with involuntary urine loss that becomes

34
Q

What are the types of urinary incontinence?

A

Stress incontinence
Urge incontinence
Mixed incontinence
Outflow incontinence

35
Q

What is stress incontinence?

A

Weakness of the urinary outlet that causes incontinence when bladder is put under pressure such as coughing or sneezing

36
Q

What is urge incontinence?

A

Sudden compelling urge to void due to high pressure

37
Q

What is mixed incontinence?

A

Combination of urge and stress incontinence

38
Q

What is outflow incontinence?

A

Dribbling or leaking urine constantly due to an overfull bladder

39
Q

What is a fistula?

A

Abnormal connection between bladder and brain

40
Q

What is an overactive bladder?

A

Sudden urge to urinate that can occur without incontinence.

41
Q

What is urinary incontinence in men?

A

Overactive bladder, overflow incontinence, prostate enlargement.

42
Q

What is urinary incontinence in women?

A

Stress incontinence, urge incontinence, mixed incontinence,

43
Q

What are the risk factors for urinary incontinence?

A

Pregnancy/childbirth/menopause
Increasing age
Obesity
Constipation
Pelvic organ prolapse
Chronic cough/smoking
Excessive weight lifting

44
Q

How does increased abdominal pressure affect the bladder?

A

Reduces renal blood flow and function.
Applies pressure to the bladder neck and reduces urinary output and causes genuine stress incontinence.

45
Q

What is genuine stress incontinence?

A

Caused by increased intrabdominal pressure where there is weakening of the urethral sphincter that causes involuntary urine loss.

46
Q

Which type of person is urinary incontinence most prevalent?

A

Elderly people-mixed and urge urinary incontinence

47
Q

What are the quality of life issues with urinary incontinence?

A

Distress, embarrassment, inconvenience, threat to self-esteem, loss of personal control, desire for normalisation

48
Q

How is female stress urinary incontinence treated?

A

Behaviour therapy pharmacological agents
Surgical treatment

49
Q

What are the behaviour therapies?

A

Biofeedback, pelvic floor exercises and vaginal weights.

50
Q

What are the pharmacological agents?

A

Oestrogens (inhibits urinary output), tricyclic antidepressants, duloxetine.

51
Q

What is the surgical treatments for incontinence?

A

Elevation of the bladder neck with a mid-urethral sling

52
Q

What is the function of the surgical incontinence?

A

It either enhances urethral resistance and/or supports bladder neck which differs in the access to the bladder neck access

53
Q

What is the intramural urethral injections?

A

Use of bulking agents such as collagen which keeps it closed.

54
Q

What are the types of sling procedures?

A

Proximal urethral slings
Mid urethral slings

55
Q

Proximal urethral slings

A

Attachment using the rectus fascia

56
Q

What is single incision mid urethral tape?

A

Effective treatment for stress incontinence with a single incision and less risk

57
Q

How is an overactive bladder treated?

A

Botox
Behaviour therpay
Anti-cholinergic
Neuromodulation with interstim therapy by stimulation of sacral nerves

Year 2 (247 decks)

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