Urinary Disorders Flashcards
what is stress incontinence
involuntary leakage of urine after an increase in intrabdominal pressure
how do you diagnose overactive bladder
cystometry
what are causes of stress incontinence
obesity
pregnancy/previous istrumental delivery
age - particularly post menopause
what are common features of stress incontinence
urgency
frequency
urge incontinence
what is the management for stress incontinence
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
what is a duloxetine and what are the side effects
nausea dry mouth dyspepsia dizziness insomnia drowsiness
what is the cure rate of a mid urethral sling
90%
what are complications of a mid urethral sling
bladder perforation post-operative voiding difficulty bleeding infection de novo detrusor overactivity suture/mesh erosion
what are the types of mid urethral sling available and how are they used
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
whats the success rate of injectible periurethral bulking agents for stress incontinence
40-60% success with 20% cure rate
whats the indication for the use of injectible periurethral bulking agents for stress incontinence
women who have not completed childbirth
frail and elderly
previous failed surgery
what is the definition of overactive bladder
frequency/urgency without the presence of a UTI due to detrusor overactivity
what is the aetiology of detrusor overactivity
idiopathic
neuropathies - MS, spinal cord injury
what are clinical features of an overactive bladder
urgency frequency nocturia leakage at night or during orgasm history of childhood eneuresis is common
what would a urinary diary show for overactive bladder
frequent passage of small volumes of urine, especially at night
when is cystometry indicated for overactive bladder
if lifestyle changes and drug management is ineffective
what is the management for overactive bladder
convervative
reduce fluids/caffeine/diuretics/antipsychotics
bladder training
medical anticholinergics sympathomimetics (mirabegron) oestrogens botox
what is the definition of overactive bladder
frequency/urgency without the presence of a UTI due to detrusor overactivity
what is the aetiology of detrusor overactivity
idiopathic
neuropathies - MS, spinal cord injury
what are clinical features of an overactive bladder
urgency frequency nocturia leakage at night or during orgasm history of childhood eneuresis is common
what would a urinary diary show for overactive bladder
frequent passage of small volumes of urine, especially at night
when is cystometry indicated for overactive bladder
if lifestyle changes and drug management is ineffective
what are causes of acute urinary retention in women
childbirth - particuarly with an epidural vulval/perineal pain surgery drugs - anticholinergics retroverted gravis uterus pelvic masses neurological disease
in what patient population are vaginal oestrogens useful for in overactive bladder
post-menopausal women
what should be considered before prescribing mirabegron for overactive bladder
blood pressure as it is associated with hypertension
when is mirabegron indicated for overactive bladder
when medical management is indicated but anticholinergics are contraindicated
what is the aetiology of incontinence in females
stress - 50%
Bladder overactivity - 35%
mixed stress/overactivity - 10%
what is the definition of acute urinary retention
no urination in 12 hours
how do you treat acute urinary retention
catheterisation
what are causes of chronic urinary retention
urethral obstruction - pelvic masses/incontinence surgery
detrusor activity - autonomic neuropathies (diabetes), previous overdistension of the bladder
how do you treat interstitial cystitis
Dietary changes
Bladder training
Analgesics
Tricyclic antidepressants
Intravesical infusion of other drugs
