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Urinary > Session 8 B > Flashcards

Session 8 B Flashcards

1
Q

Types of incontinence

A

Stress, Urgency, mixed, overflow, over active bladder

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2
Q

What is stress urinary incontinence

A

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

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3
Q

What is urgency urinary incontinence

A

The complaint of involuntary leakage of urine accompanied by or immediately proceeded by 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

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5
Q

What is overflow incontinence (chronic urinary retention)

A

The involuntary release of urine when the bladder becomes overly full- due to a weak bladder muscle or to blockage

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6
Q

What is overactive bladder

A

A frequent and sudden urge to urinate that may be difficult to control

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7
Q

Prevalence of urinary incontinence/OAB

A

OAB is higher than UUI

SUI is most common incontinence compared to UUI

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8
Q

3 factors of risk factor

A

Obs and gyn.
Predisposing
Promoting

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9
Q

O and G risk factors

A

Pregnancy and childbirth
Pelvic surgery/DXT
Pelvic prolapse

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10
Q

Predisposing risk factors

A

Family predisposition
Race
Anatomical abnormalities
Neurological abnormalities

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11
Q

Promoting risk factors

A

Co-morbidities
Obesity
Age
Increased intra abdominal pressure
Cognitive impairment
UTI
Drugs
Menopause

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12
Q

3 classes of classification for lower urinary tract symptoms

A

Storage, voiding, post-micturition

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13
Q

What do we need to rule out

A

Diabetes

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14
Q

Storage symptoms of LUTs

A

Increased frequency
Urgency
Nocturia
Incontinence

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15
Q

Voiding symptoms of LUTs

A

Slow stream
Splitting or spraying
Intermittency
Hesitancy
Straining
Terminal dribble

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16
Q

Post-micturition LUTs

A

Post micturition dribble

Feeling of incomplete emptying

17
Q

Additional factors to consider when determining type of UI

A

Fluid intake habits, particularly tea and coffee

Previous pelvic surgery

History of large babies

Symptoms of uterovaginal prolapse and faecal incontinence

18
Q

Examinations needed when investigating for Urinary incontinence

A

-BMI
-Abdo exam to exclude palpable bladder
-Examination of S2,3,4 dermatomes if suspecting neurological disease
-Digital rectal examination DRE (prostate if male)
- Females external genitalia (stress test), vaginal exam

19
Q

Investigations for urinary incontinence

A

Mandatory- urine dipstick, UTI, haematuria, proteinuria, glucosuria

Basic non-invasive urodynamics- frequency-volume chart, bladder diary over 3 days, post micturition Residual volume (in patients with voiding dysfunction)

Optional- invasive urodynamics (pressure flow studies and or video), pad tests, cystoscopy

20
Q

Conservative management of urinary incontinence

A

Modify fluid intake
Weight loss
Stop smoking
Decrease caffeine intake (UUI)
Avoid constipation
Timed voiding- fixed schedule

21
Q

Contained incontinence systems

A

For patients unsuitable for surgery who have failed conservative or medical management

Indwelling catheter- urethral or suprapubic

Sheath device- analogous to an adhesive condom attached to catheter tubing and bag

incontinence pads

22
Q

Specific management of SUI

A

Pelvic floor muscle training (PFMT)
- 8 x contractions (x3 a day)
- 3 months duration at least

Duloxetine

23
Q

Features of Duloxetine

A

Combined noradrenaline and serotonin uptake inhibitor

Increased activity in the striated sphincter during filling phase

Not recommended by NICE as first line or routine second line treatment but may be offered as alternative to surgery

24
Q

Surgery in females for SUI

A

Permanent intention
- open retropubic suspension procedures
- classical autologous sling procedures
- low tension vaginal tapes

Temporary if further pregnancies planned
- Intramural bulking agents

25
Q

Males surgery interventions for SUI

A

artificial urinary sphincter
Male sling procedure

26
Q

Features of a male artificial urinary sphincter

A

Gold standard

Urethral sphincter deficiency- neurological, post DXT or surgery

Cuff stimulates action of normal sphincter to circumferentially close the urethra

27
Q

What is DXT

A

Deep x ray therapy

28
Q

Overview of initial management of UUI

A

Bladder training

Schedule of voiding:
- void every hour during day
- must not void in between, wait or leak
- Intervals increased by 15-30 minutes a week until interval of 2-3 hours reached
- at least 6 weeks duration

29
Q

Pharmacological management of UUI

A

Anti cholinergic (acts on muscarinic receptors M2 and m3)

Many brands e.g. Oxybutynin, Solifenacin

B3 adrenoreceptor agonist- Mirabegron

30
Q

What does Mirabegron do

A

B3 adrenoreceptor agonist

Increases bladders capacity to store urine

31
Q

Side effects of anti cholinergics

A

M1- CNS, salivary glands
M2- heart smooth muscle
M3- smooth muscle (ocular and intestinal), salivary glands
M4- CNS
M5- CNS, eye

32
Q

Features of botulism toxin

A

Refractory to anticholinergics and B3 adrenoreceptor agonist

Intravesical injection of Botulinum toxin (potent biological neurotoxin, inhibits ACh release at pre-synaptic neuromuscular junction causing targeted flaccid paralysis)

Lasts 3-6 months

33
Q

Surgery refractory to pharmacological management

A

Sacral nerve neuromodulation
Autoaugmentation
Augmentation cytoplasty
Urinary diversion

34
Q

What constitutes Enuresis in children

A

Bedwetting = involuntary wetting during sleep at least 2x a week in children aged >5 years with no CNS defects

35
Q

Key questions for children with enuresis

A

Age
Primary or secondary (after 6 months of dry nights)
Daytime symptoms
Pain passing urine
Pass urine infrequently
Are they constipated

36
Q

Management in primary enuresis without daytime symptoms

A

Primary care
Reassurance, alarms with positive reward system, desmopressin

37
Q

Management in primary enuresis with daytime symptoms

A

Usually caused by disorders of the lower urinary tract e.g. anatomical, OAB

Referral to secondary care

38
Q

Management of secondary enuresis

A

Treat underlying cause if it has been identified

E.g. UTIs, constipation, diabetes, psychological problems, family problems, physical or neurological problems

Primary/secondary care

Urinary (20 decks)

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