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Y2 - Urinary > Lecture 15 - Urinary Incontinence > Flashcards

Lecture 15 - Urinary Incontinence Flashcards

1
Q

What are the 4 main types of incontinence?

A

Stress Urinary Incontinence
Urgency Urinary Incontinence
Mixed Urinary Incontinence
Overflow Incontinence

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2
Q

What is Stress Urinary Incontinence (SUI)?

A

When there’s involuntary leakage on effort or exertion, coughing or sneezing due to increased ABDOMINAL PRESSURE

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3
Q

What is Urgency Urinary Incontinence?

A

Involuntary leakage associated with urgency

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4
Q

What is Mixed Urinary Incontinence?

A

The complaint of involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing.

Stress + Urinary

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5
Q

What is overflow incontinence?

A

Involuntary release of urine when the bladder becomes overly full, can be due to a weak bladder muscle or blockage

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6
Q

What is an Over Active Bladder?

A

Frequent and sudden urge t urinatte that may be difficult to control due to overactive detrusor muscle

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7
Q

Why is the prevelance of Urgency Urinary Incontinence much higher than it actually is measured to be?

A

Lots of people dont seek medical help for it

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8
Q

What are the risk factors for Urinary Incontinence?

A

Pregnancy and childbirth
Pelvic surgery
Pelvic prolapse

Anatomical/neurological abnormalities

Obesity
Age
Inc Abdomen pressure
Menopause
UTIs
Drugs

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9
Q

Why does menopause increase risk of urinary incontinence?

A

Lack of oestrogen after menopause
Oestrogen maintains the tone of the pelvic floor muscles which the urethra passes through

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10
Q

Look at slide 7:

What type of incontinence does the patient most likely have?

A

Mixed Urinary Incontinence

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11
Q

What factors based on her history support the diagnosis?

What is the incontinence likely due to?

A

Urgency
Inc freq
Nocturia without UTI

LIkely weakness of pelvic floor due too menopause

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12
Q

What are some lower urinary tract symptoms to do with storage?

A

Increased frequency
Urgency
Nocturia
Incontinence

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13
Q

What are some lower urinary tract symptoms to do with voiding?

A

Slow stream
Splitting or spraying
Intermittency
Hesitancy
Straining
Terminal dribble

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14
Q

What are some lower urinary tract symptoms to do with post-micturition?

A

Post-micturtiion dribble
Feeling of incomplete emptying

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15
Q

How does caffeine intake affect urinary continence?

A

Acts as a diuretic

Caffeine irritates bladder leading to the need to go

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16
Q

What dermatomes should be examined if Urinary Incontinence is thought to be due to neurological damage?

A

S2, S3 and S4

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17
Q

What examinations are done in a person with urinary incontinence?

A

BMI
Abdominal exam + able to palpate bladder (not normally able to)
Neuro exam of S2,S3 and S4

DRE (prostate)

Females (external genitalia + vaginal exam)

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18
Q

What investigations are done on someone with Urinary incontinence?

A

Mandatory Urinary dipstick

Frequency vol chart
Bladder diary
Post micturition residual volume

Can do pad tests or cytoscopy

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19
Q

What is the urine dipstick testing for?

A

Ruling out UTI also diabetes
Haematuria
Proteinuria
Glucosuria

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20
Q

How do you measure post-micturition residual volume?

A

After the patient has voided you Catheterise them then drain the urine left in the bladder

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21
Q

When doing urodynamics testing what pressures are important?

A

Intravesicle pressure
Abdominal pressure
Detrusor pressure

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22
Q

Where is a probe inserted in order to measure intravesical pressure?

A

Bladder probe

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23
Q

Where is a probe inserted in order to measure abdominal pressure?

A

Rectal probe

24
Q

How do you work out detrusor pressure?

A

Bladder (intravesical pressure) - Abdominal pressure

25
What structures can prolapse through the pelvic floor if it become weak in women?
Uterus Rectum Bladder
26
What are the pelvic floor muscles?
Coccygeus Levator ani Iliococcygeus Pubococcygeus Puborectalis Puborectalis Obturator internus
27
What are some conservative management techniques for urinary incontinence?
Modify fluid intake (caffeine) Weight loss (inc Abd Pressure) Stop smoking (irritate detrusor) Avoid constipation (Inc abdominal pressure) Timed voiding
28
What is contained incontinence?
When devices like in dwelling catheters, sheath device (catheter condom) and incontinence pads are used to catch any urine
29
What can be trained as a part of management for Stress Incontinence?
Pelvic floor muscles
30
What drug can be used to treat Stress Urinary Incontinence?
Duloxetine
31
How is Duloxetine used to treat Stress Urinary Incontinence?
Noradrenaline reuptake inhibitors Meaning prolongs the action of Noradrenaline at the Internal Urethral Sphincter so it remains contracted
32
What surgery can be done in females for Stress Urinary Incontinence?
Permanent: Open retro pubic suspension procedures Low tension vaginal tapes Temporary (if further pregnancy planned): Intramural bulking agents into sphincter to make it bigger
33
What surgery can be done in males to treat Stress Urinary incontinence?
Artificial urinary sphincter Male sling procedure
34
What is an open retropubic procedure?
Mesh put inside vagina at midurethral level and is passed retroppubiclaly supporting the bladder preventing urine from being squeezed out
35
What is the gold standard surgical treatment for men in SUI?
Male artificial urinary sphincter (cuff)
36
How does the male artificial urinary sphincter work?
Cuff put around urethra Urine from bladder drains into it allowing it to swell and occlude urethra Turn off mechanism to allow urine through
37
How is Urgency Urinary Incontinence initial managed?
Bladder training: -schedule of voiding -eventually time period between voiding increases
38
How is urgency Urinary incontinence treated Pharmacologically?
Anticholinergics/antimuscarinics B3-adrenoceptor agonist
39
What is the problem with Anticholinergics?
They have many side effects due to them acting on Muuscarinic Receptors (mainly M2,M3) but act on all of them M1 = CNS salivary glands M2 = heart M3 = smooth muscle (ocular and intestinal), salivary glands
40
What is the function of Anticholinergics in treating UUI?
Inhibits the parasympathetic action of ACh at the M3 receptor on the detrusor muscle preventing it contracting
41
What is an example of antihcholinergics for UUI?
Oxybutynin Solifenacin
42
What is the function of a B3-adrenoceptor agonist?
Stimulates the sympathic actions of detrusor muscle contraction
43
How can botulism Toxin be used to treat UUI?
Injected into bladder (intravesical injection) Its a neurone toxin inhibiting release of ACh at presynaptic neuromuscular junction causing flaccid paralysis allowing the bladder to fill more
44
What surgery can be done t treat UUI?
Sacral nerve modulation Autoaugmentation Augmentation cystoplasty Urinary diversion (into a port like a stoma bag)
45
What managements can be done to treat a post menopausal woman’s UUI without surgery?
Reduced fluid intake Reduced caffeine intake Bladder training HRT (helps strengthen pelvic floor) Pelvic floor exercises Anticholinergics drugs B3 agonists
46
What managements can be done to treat a post menopausal woman’s SUI without surgery?
Duoloxtine hydrochloride Pelvic floor muscles
47
What is enuresis?
Bedwetting
48
What is considered Enuresis/bedwetting?
Involuntary wetting during sleep at least twice per week in children aged over 5yrs with no CNS defects
49
What is primary enuresis?
Nerve achieved sustained continence at night
50
What is secondary enuresis?
Restarted having been dry at night for over 6months
51
What nerve maintains voluntary continence?
Pudenal nerve
52
What hormone is usually produced in large quantities at night to help prevent enuresis?
ADH
53
How is primary enuresis managed without daytime symptoms?
Reassurance Alarms with positive reward system to wake up once start to wet bed Give desopressin when not enough ADH is being made
54
How is primary enuresis managed with daytime symptoms?
Usually caused by disorders of lower urinary tract so refer to secondary care
55
How is secondary enuresis treated?
Treat underlying cause: UTIs Constipation Diabetes Psychological problems Family problems Physcial or neuro problems
56
What is a urinary stress test?
Fill bladder then cough to see if there’s any incontinence
57
What are some investigations done when suspecting stress incontince?
Urinalysis Stress test Bladder scan Bladder diary

Y2 - Urinary (24 decks)

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