urinary incontinance

Question 1

types of incontinance

Answer 1

stress
urge
mixed
overactive

Question 2

what are the risk factors for urinary incontience

Answer 2

pressure- pregnancy, constipation, obesity
genetics- family history
medical conditions- diabetes
surgical- gyncological surgery, vaginal, forceps deliverym hysterectomy
not modifiable- age, female

Question 3

what to ask about in the history?

Answer 3

age
frequency?
volume=
symptoms= nocturia, heamuria, dysuria, cloudy
precipitating and relieving factors
dysuria, loin or groin pain, blood in the urine, foul smelling, fevers nausea or vomiting,
bowel habit b.c if constipated that caould make worse
obstruction= hesitancy, incomplete
gyn, menestral history, cervical smears normal? obs history: parity mode of delivery for each.
past medical: diabetes
surgical:
medications?
family history?
Social history what do you do as a job?

Question 4

what to look for on examination for urinary incontinance?

Answer 4

abdominal examination
(enlarged bladder or masses?)
V/E pelvic organ prolapse, masses, irritation, or inflammation)
DRE= posterior wall prolapse
digital evaluation of pelvic floor muscles
perineal sensation
cognitive assessment

Question 5

What investigations would you do for UI?

Answer 5

bloods- U&E to detect renal function baseline
urine dipstick UTI? glucose?
urinary diary- diary of fluid intake and output incontinance
cystoscopy-
IVP of methylene blue test

Question 6

stress incontinance mechanism of action

Answer 6

leak of urine due to the rise in abdominal pressure into he bladder and causes pressure within the bladder to exceed pressure within the abdomen.

Question 7

general advice for woman with stress UI?

Answer 7

weight loss
stop smoking
reduce the amount you drink
review meds stop diuretics

Question 8

non=pharmaceutical therapies stress

Answer 8

pelvic floor muscle training for 3 months

Question 9

pharmaceutical therapy stress

Answer 9

duloxetine (SNRI) increases urethral sphincter closure

Question 10

surgical interventions stress

Answer 10

tension free vaginal tape- passes through both sides of the endopelvic fascia like a sling and placed around urethra to create support.
transobduratior tape- passed through the obdurator canal.
colposuspension= vaginal wall on wither side is hitched up to the iliopectioneal sutures. stabilises the position of the bladder tenses the urethra.
periurethral bulking agents- collagen injected around the urethra to bulk the tissue and create a narrower passage.

Question 11

urge incontinance definition

Answer 11

invol. leak of urine immediately preceded by an urgency

Question 12

mechanism of urge incontinance

Answer 12

instability of the detrusor muscle leading to involuntary contractions

Question 13

overactive bladder definition

Answer 13

urgency that occurs with or without leaking and coinsides with frequency and nocturia.
differentiate by wet or dry

Question 14

treatment general urge

Answer 14

fluid restrict
bladder training
lose weight- if BMI over 30

Question 15

medical treatment of urge incontinance

Answer 15

anti-muscarinics- relaxation on urinary smooth muscle
oxybutyrin first line
darifenacin solifenacin tolterodine trosmpium
antimuscrinic- SE
intravaginal oestrogen- if vaginal atrophy
mirabegron- agonist of beta 3 receptors in detrusor smooth muscle cause relaxation use if antimuscarinic c.I

Question 16

what drug treatment can help nocturia?

Answer 16

desmopressin

Question 17

surgical treatment for urinary incontinence?

Answer 17

botulinum toxin A - wears of between injections- UTI is a risk in future
sacral nerve stimulation-
percutaneous posterior tibial nerve stimulation- short and long term options
augmentation cystoplasty-
urinary diversion