Renal & Urology Flashcards
What are the 3 main types of urinary incontinence
Stress - involuntray leakage on effort or exertion.
Urgency - involuntary leakage accompanied/ immediately proceeded by sudden compelling desire to pass urine which is difficult to defer.
Mixed - both stress and urgency incontinence. Involuntary leakage associated with both urgency & physical stress/exertion
What is Overflow incontinence?
Detrusor under-activity or bladder outlet obstruction results in urinary retention and leakage of urine. Can be caused by chronic urine retention.
There may be straining to urinate or incomplete bladder emptying
What can be an underlying cause continuous urinary incontinence?
Urogenital fistula
What are 8 risk factors predisposing one to SUI?
Increasing age (most prominent)
pregnancy & vaginal delivery (muscles and connective tissue can be weakened during delivery & damage may occur to pudendal and pelvic nerves)
obesity (increased pelvic pressure on tissues and stretching and weakening of muscles and nerves from excess weight)
Constipation (straining can weaken pelvic floor muscles)
Deficiency in supporting tissues - prolapse, hysterectomy & lack of oestrogen menopause
Family history
Smoking
Drugs eg ACEi - cough -> worsening
How to examine Urinary incontinence?
Abdominal ( + DRE) - enlarged bladder, masses, loaded colon, focal impaction & anal tone
Pelvic - prolapsed, atrophy, neurological deficit, retention of urine & pelvic masses
How to examine Urinary incontinence?
Abdominal ( + DRE) - enlarged bladder, masses, loaded colon, focal impaction & anal tone
Pelvic - prolapsed, atrophy, neurological deficit, retention of urine & pelvic masses
Which Incontinence is part of overactive bladder syndrome?
UUI
What causes the symptoms of overactive bladder syndrome?
Involuntary contractions of detrusor muscles during the filling phase of micturition cycle.
The detrusor muscle overactivity can cause urgency and frequency with or without incontinence (dry vs wet OAB)
What are the possible risk factors/ causes for UUI?
Women - mostly idiopathic. Associated with systemic neurological conditions eg. Parkinson’s disease, MS or injury to spinal/ pelvic nerves. Local irritation (bladder stones, bladder cancer, infection). Obstruction (BPH), surgery (TURP)
Adverse effects of drugs -> detrusor muscle overactivity eg. parasympathomimetics, antidepressants & HRT
Exacerbations of UUI - caffeinated, acidic or alcoholic drinks
Which medications can cause overflow incontinence?
ACEi, antidepressants, antihistamines, antimuscarinics, antiparkinsonian drugs, beta-adrenergic agonists, Calcium channel blockers, opioids & sedatives and hypnotics
Women with systemic neurological disease are more likely to develop with urinary incontinence?
Overflow incontinence
Urgency Urinary incontinence (UUI)
Women with systemic neurological disease are more likely to develop which types of urinary incontinence?
Overflow incontinence
Urgency Urinary incontinence (UUI)
How can ACEi cause SUI?
Side effect = cough -> physical exertion and worsen SUI
What is the prevalence of urinary incontinence?
Women > Men (3-11%)
Men suffers mainly from UUI, SUI accounts for <10% and stems mainly from prostate surgery, trauma or neurological injury
Why do more women suffer from urinary incontinence than men?
Due to the structural differences in urinary tract, pregnancy, vaginal delivery & menopause
What are the possible complications from UI?
Impairment of QoL - employment and leisure activities
Psychological problems - depression, anxiety, embarrassment, isolation, loss of self confidence etc
Social isolation & avoidance of going outside/ places with difficulties going to bathrooms
Sexual problems - reduced intimacy, affection & physical proximity. Women may avoid sexual intercourse if they are concerned
Loss of sleep - particularly in OAB from nocturne
Falls and fractures - esp. in old people
Financial problems - cost of absorbent products and laundry
What are the determinants for Prognosis of UI in women?
Type of UI, severity and the underlying cause.
Any contributory factors & motivation for treatments.
For a 6-year follow-up study for 42-55 yr old women with UI, over 1/2 had no change in symptoms, 1/3 had decreased incontinence & 15% had worsening symptoms
What is included in the assessment of UI in women?
Duration, type and severity of UI (frequency), possible complications (psychological, sexual and social isolation), cause & contributing factors
What is the modified Oxford grading system for quantifying the strength of contraction for digital pelvic floor muscle examination?
0 = no contraction 1 = flicker. Flicker/ pulsation felt under the examiner's finger 2 = weak. An increase in tension detected, without discernible lift. 3 = moderate. There is a lifting of the muscle belly and also elevation of the posterior vaginal wall 4 = good. Increased tension and good contraction elevate the posterior vaginal wall against resistance (pressure by the examining finger applied to the posterior vaginal wall) 5 = strong. Strong resistance is applied to the elevation of the posterior vaginal wall. The examiner's finger is squeezed and drawn into the vagina
What are the 3 main neurological conditions that can cause UI?
Parkinson’s disease, Multiple sclerosis, pelvic/ spinal cord injury
Which investigation should be done to all women presenting with UI and why?
Urinary dipstick analysis - blood, leukocytes, nitrate, pH, glucose & protein
If leukocytes and nitrate present, send sample for MSU - C&S… sign of UTI (treat with antibiotics immediately)
How to determine the severity of UI during history taking?
Frequency of incontinence, during what times and during which activities,
Pads - usage of pads, size or change of clothing,
Ask to keep a BLADDER DIARY for min. 3 days - make sure to cover all variation of normal activities
How to determine the severity of UI during history taking?
Frequency of incontinence, during what times and during which activities,
Pads - usage of pads, size or change of clothing,
Ask to keep a BLADDER DIARY for min. 3 days - make sure to cover all variation of normal activities
What should be contained in the bladder diary?
Amount, type and timing of fluid intake, Voided volume, Frequency of micturition, Episodes of urgency, Episodes of incontinence, Activities causing leakage, Pad & clothing changes
