Urianary Incontiance Flashcards
What are the somatic nerves that control the soincthers of the bladder?
The puendal nerve (S2’ 3’ 4)
Which of the nervous systems are the detrusors muscles are under the influence of?
The
Parasympatheic neruones S2S3S4
What are the differnt parts of filling?
Compliance (receptive relaxation), sensation of bladder feeling and no detrusor contraction
What are the two parts of vooding?
Voluntary initation and complete emptying
What are soem of the effects of a lower motor nuerone lesion on the bladder?
Low detrusor pressure and large residual urine +- overflow incontiance
What effects do an unpper motor neurone lesion have on the bladder?
High pressure detrusor contractions and poor coordination with spinchters
What are some of the classifactions of LUTS?
Sumptoms realating to storage, voidign and post mircoturition
What is urnianry inctoninence?
The complaint of involuntary leakeage of uirne
What are the different types of imcontiance?
Stress urinary incontainence, urge urianary incontinence, and mixed urinary incontinence
What is stress urinary incroninance?
The complaint kf involuntary leakage of effort or excertion, such as sneezing or coughing
What is urger urinary incontinenence?
The complaint o finvoluntary leakage of urine accompanied by or immeadalty proceeded by urgency
What are some of the features of mixed urinary incontience?
The complaint of involuntart leakage of urine associated with urgency and also with excertion effor sneezing or coughing
What are some of the Oand G rsik factors for inctonitnece?
Pregancy and childbrith, pelvis srugery and DXt and pelvis prolaspe
What are some of the predisposing factors?
Race, family predispostion, anatical abnormalities and neuroligcal abonormlaities
What are some of the promoting factors?
Co morbifpditis, obesitiy, age, increased intra abdo pressure, cognitive impariemnt, durgs p, uti and menopause
What are some of the examinations you may do with incontiance?
BMI, andominal exam to exclude palanle bladder, a digital rectal exam of lrostate on males, and in females the external gentialia stress test adn a vaginal exam
What are some of investigations that you would perform?
Urine dipstick, UTI, heamaturia, proteinuria, glucosuria, frequcny volume chart, a bladder diary, post micturnition residual volime, and invasive urodynamics, pad tests, cytoscopy
What are some of the conservative managements of incotinance?
Modify fluid intake, weight loss, stop smoking, decrease caffeint intake, avoid constipation and timed voiding and a foxed sceudupe
What are some of the features of contained incontinace treated?
Used in patients that are unsulitable for surgery, indwelling catheter, urethral or suprapubic, sheath device, analoguous to an adhesive condon, and incontinence pads
What is the intial managment for SUI?
Pelvic floor musicle trainig, 8 contractions a day, and this is at least for 3 months duration
What is the pharmological managment for SUI?
Duloxetine, is combined noradrenaline and serotonin uptake, and increase activity in the striated spincther during the filling period, not recommened as a first line or routine treatment
What would be the surgerical treatments?
Females, there are permanent intention, low tension vaginal tapes, open retropubic suspension procedures, classical sling procedures, and temproy intention if futher pregancies planned, such as intramural bulking agent, males are a artifical urianary spinchter
What is the management fo urge urainarry incontiance?
Bladader training, such as schedule of voiding, vodi ever hour druing the day, must nor vodi inbetween, wait or leak, or intervals increase by 15-30 minutes a week until a interval of 2-3 hours reached for at least 6 hours duration
What is the pharmacoligcal managment of UUi?
Anticholinergics, act on muscarininc receptors, M2 and M3, and side effects due to affewcts on M receptors, such as M1 for the CNS and slavaroart glands, called oxybutin
What are some of the surgical interventions for urge urinary incontinace?
Sacral nerve neuromodulation, autoaugemntation, augementation cystoplasty, urinary diversion
