L14: Voiding Problems Flashcards
What can urinary symptoms be divided into
Voiding (obstructive)
Storage
Post micturition
What are the voiding (obstructive) symptoms
Hesitancy Poor or intermittent stream Straining Incomplete emptying Terminal dribbling
What are the storage urinary symptoms
Urgency
Frequency
Nocturia
Urinary incontinence
What are the post micturition symptoms
Post micturition dribbling
Sensation of incomplete emptying
What is urinary incontinence
Involuntary leakage of urine
What are the type of incontinence
Stress incontinence Urge incontinence Mixed incontinence Overflow incontinence Continuous incontincene Neurogenic incontinence
What is stress incontinence
When the pressure of the bladder exceeds the urethral pressure and can be caused by coughing, straining, laughing, lifting
What is the cause of stress incontinence
Weak pelvic floor muscle
What are the risk factors for stress incontinence
Post partum
Continuation due to strainign
Pelvic surgery
Post menopausal
What is urge incontinence
A sudden desire to urinate and is an overactive bladder caused by the destructor muscle over activity. It leads to an inhibited bladder contraction that causes a rise in the intra vesical pressure and leakage of urine
What are the causes of urge incontinence
Neurogenic- previous stroke Infection Malignancy Idiopathic Medication; cholensterase inhibitors
What is overflow incontinence
Due to progressive stretching of the bladder wall that causes damage to the efferent fibres of the sacral reflex and loss of bladder sensation
What are the causes of overflow incontinence
Prostatic hyperplasia
Spinal cord injury
Congenital defects
What investigation can be carried out in incontinence
Post void bladder scan in overflow incontinence Vaginal spectrum MRI Dipstick for haematuria or infection Cystoscopy Intra vesicular urogram
What is the treatment for stress incontinence
Pelvic floor muscle training
Duloxetine
Surgery
What is the treatment for urge incontinence
Oxybutynin Tolterodine Mirabegron Bladder training Surgery
What is the treatment for overflow incontinence
Treat BPH
What are the 3 natural points where renal stones are likely to get trapped
Pelvic ureteric junction Pelvic brim (where the ureter enters the pelvis and crosses the iliac vein( Vesico-ureteric junction (ureter passes the vas deferens)
What are the risk factors for kidney stones
Dehydration Previous calculus Hypercalcaemia Hyperuricaemia Inherited condition Structural abnormalities of the urinary tract
What can a renal stone be made of
Calcium
Struvite
Uric acid
Cysteine
Which type of stone is the most common
Calcium renal stones
Which renal stone is related to chronic uti
Struvite
What is the presentation of kidney stones
Sudden onset of loin to groin pain
Describe the SOCRATES of a ureteric colic pain
S-loin O-sudden C-throb/cramp R- groin A: haematuria, dysuria, frequency T: comes in waves E: movement S: 10/10
What is the gold standard investigation for renal stone
Ct of the urinary tract
What is the management of renal stones
Fluid
Majority will pass stone without invtervention
Analgesia for pain
Septic- antibiotics
If obstruction: nephrostomy or ureteric stent insertion
What is the management if the stone is less than 10mm and there is no obstruction
Conservative
What is the management of a renal stone that is more than 10mm with no obstruction
Uretescopy and laser fragmentation to break up the stone
What is the chemical composition of a stone
Calcium oxalate- majority Calcium phosphate Uric acid Cystine Magnesium ammonium phosphate
Why do the majority of stone form due
Metabolic causes
What is the metabolic cause of calcium
Hyperparathyroidism
Dietary excess
Absorptive hypercalciuria: increases calcium absorption form the gut
Renal leak hypercalciuria- leak of calcium from the kidney
Excess vitamin d and calcium supplements
Renal tubular acidosis
Prolonged immobilisation
Sarcoidosis
What are the other metabolic causes due to oxalate
Hereditary hypoeroxaluria
Dietary excess
Intestinal disease: Crohn’s and ulcerative colitis
What is hereditary hypoeroxaluria
A condition where there is a problem with an enzyme in the liver which has to break down oxalate, a lack of the enzyme leads to hyperoxaluria leading to a stone formation
How does intestinal disease such as Crohn’s and ulcerative colitis cause hypoeroxaluria
Fatty acids in the gut bind with dietary calcium which prevents the excessive oxalative absorption by the gut into the circulation. In Crohn’s disease and ulcerative colitis, fatty acids is not Brocken down so the gut absorbs oxalate unbound to calcium
What are the metabolic causes of uric acid
Dietary excess of animal protein
Gout related
High cell turnover
What is the medical management of renal stones
Increase fluid uptake and for urine output of 2.5-3 litres Reduce meat intake Avoid oxalate rich foods Reduce milk and milk products Avoid added salt
What is the pharmacological management of renal stones
Allopurinol- in uric acid and uricosuric oxalate stone
Pottassium citrate: in uric acid and cystine stones
Penicillamine: for cystine stone
Thiazide diuretics: in renal hypercalciuria
Calcium carbonate in malabsorption
What are the differential diagnosis in renal stones
Gallstone colic Appendicitis Ovarian torsion Leaking aneurysm Shingles Pnuemonia/pleural effusion
