Retention and Incontinence Flashcards
define acute urinary retention
a medical emergency characterised by an abrupt development of inability to pass urine over many hours
risk factors of acute urinary retention
> 50 yrs
male sex
MH of BPH
clinical features of acute urinary retention
complete inability to urinate despite urge
abdominal/pelvic pain
bladder distension
investigations of acute urinary retention
bladder US
CT pelvis
bloods (FBC, U+Es, PSA and glucose)
management of acute urinary retention
immediate catheterisation
treatment of underlying trigger
define chronic urinary retention
an incomplete emptying of the bladder, occurring over a prolonged time period
common causes of chronic urinary retention
BPH
prostate cancer
pharmacological causes
congenital conditions
risk factors of chronic urinary retention
male sex
age >50yrs
increased age
use of H1 receptor antagonists
clinical features of chronic urinary retention
urinary frequency weak/interrupted stream nocturia abdominal swelling + discomfort urgency but no voiding
investigations of chronic urinary retention
post-void residual measurement
renal tract US
cystoscopy
management of chronic urinary retention
intermittent or long-term catheter
urostomy
complications of chronic urinary retention
post-obstructive diuresis
CKD
hydronephrosis
define stress incontinence
leakage of the urine during times of increased abdominal pressure (e.g. laughing, coughing or squatting)
risk factors of stress incontinence
childbirth (especially vaginal)
hysterectomy
define urge incontinence
the sudden and involuntary loss of urine accompanied by extreme urgency
risk factors of urge incontinence
recurrent UTIs high BMI advancing age smoking caffeine
define overflow incontinence
a condition which causes leakage of urine without warning
causes of overflow incontinence
underactivity of detrusor muscle due to neurological damage or due to constipation or prostatism
define functional incontinence
involves the individual having the urge to pass urine but are unable to due to lacking necessary access
causes of functional incontinence
sedating medications
alcohol
dementias
conservative management of stress incontinence
avoiding caffeine, sugary drinks and excess fluid intake
pelvic floor exercises
medical management of stress incontinence
duloxetine but only if conservative measurements fail
surgical management of stress incontinence
incontinence pessaries
bulking agent placement
colposuspension
gold standard management of stress incontinence
mid-urethral slings
conservative management of urge incontinence
bladder diary
avoiding caffeine, fizzy drinks and excess fluids
pelvic floor exercises
medical management of urge incontinence
anticholinergic medication (e.g. oxybutynin, tolterodine and fesoterodine)
bladder instillation
sacral neuromodulation
