Lecture 22 Urinary Incontinence Flashcards
What nerve supply to the bladder is responsible for storage
Hypogastric nerve
Sympathetic
T10-L2
What nerve supply to the bladder is responsible for voiding
Pelvic Nerve
Parasympathetic
S2-S4
What is urinary incontinence
Any involuntary leakage of urine
What is stress urinary incontinence
Involuntary leakage on effort or exertion on sneezing or coughing
What is urgent incontinence
Involuntarily leakage accompanied by or immediately preceded by urgency
What is mixed urinary incontinence
Involuntary leakage accompanied by or immediately preceded by urgency & on effort or exertion or on sneezing or coughing
What are the risk factors of urinary incontinence
Age Parity Menopause Smoking Medical problems Increase intra abdo pressure Pelvic floor trauma Denervation Connective tissue disease Surgery
What investigations are involved with investigating urinary incontinence
MSSU+/-Multistix
Post voiding residual volume assessment
Urodynamics: uroflowmetry, Cystometry
When does stress incontinence occur
When intra-abdominal pressure exceeds urethral pressure
What lifestyle changes can be introduced to help manage urinary incontinence
Stop smoking Lose weight Eat more healthy to avoid constipation Stop drinking alcohol and caffeine Pelvic floor muscle training
What is the pharmacological management for urinary incontinence
Yentreve (Duloxetine)
Who should receive Duloxetine
Primary care: if PFMT fails
Secondary care: if they do not wish to have surgery, failed surgery or are not fit for surgery
Name a surgical management of female urinary incontinence
Tension free vaginal tape
What is the oral pharmacological of overactive bladder
- Solifenacin (Vesicare 5-10mg )
- Fesoteridine (Toviaz 4-8 mg)
- Trospium Chloride (60mg XL)
- Darifencain (Emselex 7.5-15 mg ) – Constipation; FI
- Lyrinel XL (10-20 mg )
- Oxybutinin (5-10 mg/ tds
What are the dermal and invasive management of overactive bladder
Botox
Neuromodulation
Kentera patches
