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Gynaecology > Urinary Disorders > Flashcards

Urinary Disorders Flashcards

1
Q

what is stress incontinence

A

involuntary leakage of urine after an increase in intrabdominal pressure

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2
Q

how do you diagnose overactive bladder

A

cystometry

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3
Q

what are causes of stress incontinence

A

obesity
pregnancy/previous istrumental delivery
age - particularly post menopause

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4
Q

what are common features of stress incontinence

A

urgency
frequency
urge incontinence

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5
Q

what is the management for stress incontinence

A

Conservative
Pelvic floor contractions
At least 8 contractions each time, 3 times a day
Pelvic cones can be inserted into the vagina and held there to help as well

Medical
Duloxetine

Surgical
mid urethral sling
injectible periurethral bulking agents

Bladder retraining

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6
Q

what is a duloxetine and what are the side effects

A 
nausea
dry mouth
dyspepsia
dizziness
insomnia 
drowsiness
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7
Q

what is the cure rate of a mid urethral sling

A

90%

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8
Q

what are complications of a mid urethral sling

A 
bladder perforation
post-operative voiding difficulty 
bleeding
infection
de novo detrusor overactivity 
suture/mesh erosion
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9
Q

what are the types of mid urethral sling available and how are they used

A

tension free vaginal tape - tape is applied in a U shape under the urethra and tension is adjusted to prevent leakage

transobturator tape - tape passed through the transobturator foramen

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10
Q

whats the success rate of injectible periurethral bulking agents for stress incontinence

A

40-60% success with 20% cure rate

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11
Q

whats the indication for the use of injectible periurethral bulking agents for stress incontinence

A

women who have not completed childbirth
frail and elderly
previous failed surgery

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12
Q

what is the definition of overactive bladder

A

frequency/urgency without the presence of a UTI due to detrusor overactivity

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13
Q

what is the aetiology of detrusor overactivity

A

idiopathic

neuropathies - MS, spinal cord injury

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14
Q

what are clinical features of an overactive bladder

A 
urgency 
frequency 
nocturia
leakage at night or during orgasm 
history of childhood eneuresis is common
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15
Q

what would a urinary diary show for overactive bladder

A

frequent passage of small volumes of urine, especially at night

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16
Q

when is cystometry indicated for overactive bladder

A

if lifestyle changes and drug management is ineffective

17
Q

what is the management for overactive bladder

A

convervative
reduce fluids/caffeine/diuretics/antipsychotics
bladder training

medical 
anticholinergics 
sympathomimetics (mirabegron) 
oestrogens 
botox
18
Q

what is the definition of overactive bladder

A

frequency/urgency without the presence of a UTI due to detrusor overactivity

19
Q

what is the aetiology of detrusor overactivity

A

idiopathic

neuropathies - MS, spinal cord injury

20
Q

what are clinical features of an overactive bladder

A 
urgency 
frequency 
nocturia
leakage at night or during orgasm 
history of childhood eneuresis is common
21
Q

what would a urinary diary show for overactive bladder

A

frequent passage of small volumes of urine, especially at night

22
Q

when is cystometry indicated for overactive bladder

A

if lifestyle changes and drug management is ineffective

23
Q

what are causes of acute urinary retention in women

A 
childbirth - particuarly with an epidural 
vulval/perineal pain 
surgery
drugs - anticholinergics 
retroverted gravis uterus 
pelvic masses 
neurological disease
24
Q

in what patient population are vaginal oestrogens useful for in overactive bladder

A

post-menopausal women

25
Q

what should be considered before prescribing mirabegron for overactive bladder

A

blood pressure as it is associated with hypertension

26
Q

when is mirabegron indicated for overactive bladder

A

when medical management is indicated but anticholinergics are contraindicated

27
Q

what is the aetiology of incontinence in females

A

stress - 50%
Bladder overactivity - 35%
mixed stress/overactivity - 10%

28
Q

what is the definition of acute urinary retention

A

no urination in 12 hours

29
Q

how do you treat acute urinary retention

A

catheterisation

30
Q

what are causes of chronic urinary retention

A

urethral obstruction - pelvic masses/incontinence surgery

detrusor activity - autonomic neuropathies (diabetes), previous overdistension of the bladder

31
Q

how do you treat interstitial cystitis

A

Dietary changes

Bladder training

Analgesics

Tricyclic antidepressants

Intravesical infusion of other drugs

Gynaecology (14 decks)

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