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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
Q

What structures can prolapse through the pelvic floor if it become weak in women?

A

Uterus
Rectum
Bladder

26
Q

What are the pelvic floor muscles?

A

Coccygeus
Levator ani
Iliococcygeus
Pubococcygeus
Puborectalis
Puborectalis
Obturator internus

27
Q

What are some conservative management techniques for urinary incontinence?

A

Modify fluid intake (caffeine)
Weight loss (inc Abd Pressure)
Stop smoking (irritate detrusor)
Avoid constipation (Inc abdominal pressure)
Timed voiding

28
Q

What is contained incontinence?

A

When devices like in dwelling catheters, sheath device (catheter condom) and incontinence pads are used to catch any urine

29
Q

What can be trained as a part of management for Stress Incontinence?

A

Pelvic floor muscles

30
Q

What drug can be used to treat Stress Urinary Incontinence?

A

Duloxetine

31
Q

How is Duloxetine used to treat Stress Urinary Incontinence?

A

Noradrenaline reuptake inhibitors
Meaning prolongs the action of Noradrenaline at the Internal Urethral Sphincter so it remains contracted

32
Q

What surgery can be done in females for Stress Urinary Incontinence?

A

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
Q

What surgery can be done in males to treat Stress Urinary incontinence?

A

Artificial urinary sphincter
Male sling procedure

34
Q

What is an open retropubic procedure?

A

Mesh put inside vagina at midurethral level and is passed retroppubiclaly supporting the bladder preventing urine from being squeezed out

35
Q

What is the gold standard surgical treatment for men in SUI?

A

Male artificial urinary sphincter (cuff)

36
Q

How does the male artificial urinary sphincter work?

A

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
Q

How is Urgency Urinary Incontinence initial managed?

A

Bladder training:
-schedule of voiding
-eventually time period between voiding increases

38
Q

How is urgency Urinary incontinence treated Pharmacologically?

A

Anticholinergics/antimuscarinics

B3-adrenoceptor agonist

39
Q

What is the problem with Anticholinergics?

A

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
Q

What is the function of Anticholinergics in treating UUI?

A

Inhibits the parasympathetic action of ACh at the M3 receptor on the detrusor muscle preventing it contracting

41
Q

What is an example of antihcholinergics for UUI?

A

Oxybutynin
Solifenacin

42
Q

What is the function of a B3-adrenoceptor agonist?

A

Stimulates the sympathic actions of detrusor muscle contraction

43
Q

How can botulism Toxin be used to treat UUI?

A

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
Q

What surgery can be done t treat UUI?

A

Sacral nerve modulation
Autoaugmentation
Augmentation cystoplasty
Urinary diversion (into a port like a stoma bag)

45
Q

What managements can be done to treat a post menopausal woman’s UUI without surgery?

A

Reduced fluid intake
Reduced caffeine intake
Bladder training
HRT (helps strengthen pelvic floor)
Pelvic floor exercises
Anticholinergics drugs
B3 agonists

46
Q

What managements can be done to treat a post menopausal woman’s SUI without surgery?

A

Duoloxtine hydrochloride
Pelvic floor muscles

47
Q

What is enuresis?

A

Bedwetting

48
Q

What is considered Enuresis/bedwetting?

A

Involuntary wetting during sleep at least twice per week in children aged over 5yrs with no CNS defects

49
Q

What is primary enuresis?

A

Nerve achieved sustained continence at night

50
Q

What is secondary enuresis?

A

Restarted having been dry at night for over 6months

51
Q

What nerve maintains voluntary continence?

A

Pudenal nerve

52
Q

What hormone is usually produced in large quantities at night to help prevent enuresis?

A

ADH

53
Q

How is primary enuresis managed without daytime symptoms?

A

Reassurance
Alarms with positive reward system to wake up once start to wet bed

Give desopressin when not enough ADH is being made

54
Q

How is primary enuresis managed with daytime symptoms?

A

Usually caused by disorders of lower urinary tract so refer to secondary care

55
Q

How is secondary enuresis treated?

A

Treat underlying cause:
UTIs
Constipation
Diabetes
Psychological problems
Family problems
Physcial or neuro problems

56
Q

What is a urinary stress test?

A

Fill bladder then cough to see if there’s any incontinence

57
Q

What are some investigations done when suspecting stress incontince?

A

Urinalysis
Stress test
Bladder scan
Bladder diary

Urinary (24 decks)

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