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US > Session 7: Urinary Incontinence > Flashcards

Session 7: Urinary Incontinence Flashcards

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U.S. Geography flashcards
1
Q

Classifications of lower urinary tract symptoms (LUTS)

A

Storage, voiding, post-micturition

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2
Q

LUTS of storage

A

Increased frequence, urgency, nocturia, incontinence

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3
Q

LUTS of voiding

A

Slow stream, splitting, spraying, intermittency, hesitancy, straining, terminal dribble.

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4
Q

LUTS of post-micturition

A

Post-micturition dribble, feeling of incomplete emptying.

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5
Q

Social problems with urinary incontinence.

A

Massive impact on quality of life, social exclusion, sense of shame.

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6
Q

Types of incontinence.

A

Stress urinary incontinence SUI

Urgency urinary incontinence UUI

Mixed urinary incontinence MUI

Overflow urinary incontinence OUI

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7
Q

Define SUI

A

Complaint of involuntary leakage on effort or exertion, or on sneezing, coughing etc..

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8
Q

Define UUI

A

The complaint of involuntary leakage of urine accompanied by or immediately proceeded by urgency. (Not making it to bathroom in time)

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9
Q

Define MUI

A

The complaint of involuntary leakage of urine associated with the urgency and also with extertion, effort, sneezing, coughing etc…

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10
Q

Define OUI

A

Involuntary micturition due to an overfull bladder

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11
Q

What is the most common form of incontinence?

A

SUI

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12
Q

Risk factors of UI

A

Pregnancy and childbirth, pelvic surgery, X-ray, pelvic prolapse.

Race, family predisposition, anatomical abnormalities, neurological abnormalities.

Menopause, drugs, UTI, obesity, age, chronic coughing.

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13
Q

Examination to determine UI.

A

BMI

Abdo exam to exclude a palpable bladder.

Digital rectal examination (male)

External genitalia stress test (Female)

Vaginal exam

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14
Q

Investigations of UI.

A

Urine dipstick for UTI, haematuria, proteinuria, glucosuria

Urodynamics like frequency-volume chart, bladder diary, post-micturition residual volume.

Pad tests

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15
Q

General conservative management of UI.

A

Modify fluid intake

Weight loss

Stop smoking

Decreased caffeine intake

Avoid constipation

Timed voiding

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16
Q

Other optional general treatments of UI.

A

Patients unsuitable for surgery but do not respond to conservative or medical treatment.

Urethral or suprapubic catheter.

Sheath device like a condom catheter.

Incontinence pads.

17
Q

Initial management of SUI.

A

Pelvic floor muscle training for at least 3 months duration.

18
Q

Pharmalogical management of SUI.

A

Duloxetine which is combined noradrenaline and serotonin. This increased the activity of the striated sphincter (EUS) during the filling phase to prevent incontinence.

19
Q

Surgery for SUI in females.

A

Permanent intention (sling procedure).

20
Q

Surgery for SUI in males.

A

Artificial urinary sphincter

Male sling procedure

21
Q

Initial management of UUI.

A

Bladder training

22
Q

Explain bladder training.

A

Schedule of voiding where you void every hour during the day. You must not void in between, you either wait or leak.

Intervals increased by 15-30 minutes a week until interval is around 2-3 hours.

This is done for at least 6 weeks duration.

23
Q

Pharmagolocial management of UUI.

A

Anticholinergics acting on M3 receptors.

B3-adrenoceptor agonists.

24
Q

Explain the effects of anticholinergics.

A

Antagonist of M3 to prevent involuntary contraction of the bladder

25
Q

Side effects of anticholinergics as a treatment for UUI.

A

Can affect other organs.

There is such a thing as anticholinergic load where if you are on too much anticholinergics it can lead to cognitive damage.

26
Q

Effects of B3-adrenoceptor agonists.

A

Causes more relaxation of bladder to increase the bladder’s capacity to store urine. Also increases tone of EUS.

27
Q

Side effects of B3-adrenoceptor agonists.

A

In case of high BP this might not be favourable.

Can affect other organs.

28
Q

Other pharmacological UUI treatments.

A

Intravesical injection of botulinum toxin. Inhibits the release of ACh at the pre-synaptic neuromuscular junction causing targeted flaccid paralysis.

29
Q

Define enuresis in children.

A

Bedwetting. Involuntary wetting during sleep at least 2 times a week in children aged >5 years with no CNS defects.

30
Q

Key questions of enuresis in children.

A

Age?

Primary (always bed wetted) or secondary (stopped bed wetting then and then started again)?

Daytime symptoms?

Pain passing urine?

Constipation?

31
Q

Management of primary enuresis without daytime symptoms.

A

Managed in primary care with reasurrance, alarms with positive reward system and eventual desmopressin.

32
Q

Management of primary enuresis with daytime symptoms.

A

Usually caused by disorders of lower urinary tract like anatomical or over-active bladder.

Referral to secondary care

33
Q

Management of secondary enuresis.

A

Treat underlying cause like UTI, constipation, diabetes etc…

34
Q
A

US (29 decks)

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