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Gen surg > Urinary incontinence > Flashcards

Urinary incontinence Flashcards

1
Q

Population most affected by urinary incontinence

A

Elderly females

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2
Q

Risk factors for urinary incontinence

A 
advancing age
previous pregnancy and childbirth
high body mass index
hysterectomy
family history
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3
Q

Classification of urinary incontinence

A

Overactive bladder/urge

Stress

Mixed

Overflow

Functional

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4
Q

What causes urge incontinence

A

due to detrusor overactivity

the urge to urinate is quickly followed by uncontrollable leakage ranging from a few drops to complete bladder emptying

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5
Q

What causes stress incontience

A

weakness of the pelvic floor and sphincter muscles. This allows urine to leak at times of increased pressure on the bladder

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6
Q

Features of stress incontinence

A

leaking small amounts when coughing or laughing

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7
Q

Typical description of urge incontinence

A

suddenly feeling the urge to pass urine, having to rush to the bathroom and not arriving before urination occurs

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8
Q

When does overflow incontinence occur

A

chronic urinary retention due to an obstruction to the outflow of urine. Chronic urinary retention results in an overflow of urine, and the incontinence occurs without the urge to pass urine

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9
Q

Causes of overflow incontinence

A

anticholinergic medications

fibroids

pelvic tumours and neurological conditions such as multiple sclerosis, diabetic neuropathy and spinal cord injuries

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10
Q

What should women with suspected overflow incontinence be referred for

A

Urodynamic testing

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11
Q

Risk factors for urinary incontinence

A 
Increased age
Postmenopausal status
Increase BMI
Previous pregnancies and vaginal deliveries
Pelvic organ prolapse
Pelvic floor surgery
Neurological conditions, such as multiple sclerosis
Cognitive impairment and dementia
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12
Q

Purpose of bimanual examination in urinary incontinence

A

Examination should assess the pelvic tone and examine for:

Pelvic organ prolapse
Atrophic vaginitis
Urethral diverticulum
Pelvic masses

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13
Q

Grading system used to assess strength of pelvic muscle contractions

A

Modified Oxford grading system

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14
Q

Initial ix for urinary incontinence

A

Bladder diary
Urine dip
Post-void residual bladder volume

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15
Q

Modifiable lifestyle factors contributing to urinary incontinence

A

Caffeine consumption
Alcohol consumption
Medications
Body mass index (BMI)

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16
Q

Questions to ask about severity of urinary incontinence

A

Frequency of urination
Frequency of incontinence
Nighttime urination
Use of pads and changes of clothing

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17
Q

Mx of stress incontinence

A

Avoiding caffeine, diuretics and overfilling of the bladder

Avoid excessive or restricted fluid intake

Weight loss (if appropriate)

Supervised pelvic floor exercises for at least three months before considering surgery

Surgery

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18
Q

Medication for stress incontinence

A

Duloxetine is an SNRI antidepressant used second line where surgery is less preferred

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19
Q

Surgical options for mx of stress incontinence

A

Tension-free vaginal tape

Autologous sling procedures

Colposuspension

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20
Q

Mx of urge incontinence

A

Bladder retraining (gradually increasing the time between voiding) for at least six weeks is first-line

Anticholinergic medication, for example, oxybutynin, tolterodine and solifenacin

Invasive procedures where medical treatment fails

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21
Q

Alternative to anticholinergic meds in urge incontinence mx

A

Mirabegron is an alternative to anticholinergic medications

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22
Q

Invasive options for OAB

A

Botulinum toxin type A injection into the bladder wall

Percutaneous sacral nerve stimulation involves implanting a device in the back that stimulates the sacral nerves

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23
Q

Mx of catheter-associated UTI

A

No treatment if asymptomatic

Abx for 7 days if symptoms

Catheter changed asap

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24
Q

Types of testicular cancer

A

Seminomas

Non-seminomas

25
Q

Risk factors for testicular cancers

A

Undescended testes
Male infertility
Family history
Increased height

26
Q

Presentation of testicular cancer

A 
Painless non-tender lump 
Hard 
Irregular 
Non fluctuant 
No transillumination
27
Q

Association between gynaecomastia and testicular cancer

A

gynaecomastia (breast enlargement) can be a presentation of testicular cancer, particularly a rare type of tumour called a Leydig cell tumour

28
Q

IX in testicular cancer

A

Scrotal ultrasound
AFP(teratomas)
Beta-hCG(both teratomas and seminomas)
LDH

Staging CT

29
Q

Staging system used for testicular cancer

A

Royal Marsden staging system

30
Q

Common sites for mets from testicular cancer

A

Lymphatics
Lungs
Liver
Brain

31
Q

Mx of testicular cancer

A

Surgery to remove the affected testicle (radical orchidectomy) – a prosthesis can be inserted
Chemotherapy
Radiotherapy
Sperm banking

32
Q

Long term side effects of treatment for testicular cancer

A 
Infertility
Hypogonadism (testosterone replacement may be required)
Peripheral neuropathy
Hearing loss
Lasting kidney, liver or heart damage
Increased risk of cancer in the future
33
Q

Examination findings with hydrocele

A

The testicle is palpable within the hydrocele
Soft, fluctuant and may be large
Irreducible and has no bowel sounds (distinguishing it from a hernia)
Transilluminated by shining torch through the skin, into the fluid (the testicle floats within the fluid)

34
Q

Causes of hydroceles

A 
Idiopathic 
Testicular cancer 
Testicular torsion 
Epididymo-orchitis 
Trauma
35
Q

Mx of hydroceles

A

Exclude cancer
Conservatively if idiopathic
Surgery,aspiration or sclerotherapy in large and symptomatic cases

36
Q

What is a varicocele

A

veins in the pampiniform plexus become swollen

37
Q

Presentation of varicocele

A

Throbbing/dull pain or discomfort, worse on standing
A dragging sensation
Sub-fertility or infertility

38
Q

Which side to most varicoceles occur and what can it indicate

A

The right testicular vein drains directly into the inferior vena cava. The left testicular vein drains into the left renal vein.

Most varicoceles (90%) occur on the left due to increased resistance in the left testicular vein. A left-sided varicocele can indicate an obstruction of the left testicular vein caused by a renal cell carcinoma.

39
Q

Examination findings in varicocele

A

A scrotal mass that feels like a “bag of worms”
More prominent on standing
Disappears when lying down
Asymmetry in testicular size if the varicocele has affected the growth of the testicle

40
Q

Mx of varicoceles

A

Uncomplicated cases can be managed conservatively.

Surgery or endovascular embolisation may be indicated for pain, testicular atrophy or infertility.

41
Q

Examination findings - epididymal cysts

A 
Soft, round lump 
Typically at the top of the testicle
Associated with the epididymis
Separate from the testicle
May be able to transilluminate large cysts
42
Q

Mx of epididymal cysts

A

Usually harmless

Can occasionally cause pain/discomfort - may need removal

Can be torsion of cyst causing acute pain and swelling

43
Q

Most common types of RCCs

A 
Clear cell(80%) 
Papillary(15%)
44
Q

Risk factors for RCC

A 
Smoking
Obesity
Hypertension
End-stage renal failure
Von Hippel-Lindau Disease
Tuberous sclerosis
45
Q

Presentation of RCC

A

Haematuria
Vague loin pain
Non-specific symptoms of cancer
Asymptomatic

46
Q

When should patients be referred for haematuria

A

Aged over 45 with unexplained visible haematuria, either without a UTI or persisting after treatment for a UTI

47
Q

What does cannonball metastases refer to

A

“Cannonball metastases” in the lungs are a classic feature of metastatic renal cell carcinoma. These appear as clearly-defined circular opacities scattered throughout the lung fields on a chest x-ray.

48
Q

Parneoplastic features of RCC

A

Polycythaemia
Hypercalcaemia
HTN
Stauffer’s syndrome

49
Q

Staging system for RCC

A

TNM

50
Q

Mx of RCC- surgical

A

Partial nephrectomy
Radical nephrectomy

MDT

51
Q

Mx of RCC - less invasive procedures

A

Arterial embolisation
Percutaneous cryotherapy
Radiofrequency ablation

Chemo/radiotherapy

52
Q

Mx of renal stones pain - medication

A

NSAIDs(diclofenac)

53
Q

Why is clotting an important investigation in renal stones management

A

if percutaneous intervention planned

54
Q

Main imaging ix in renal stones

A

non-contrast CT KUB within 14 hrs of admission

Ultrasound

55
Q

Mx of renal stones <5mm

A

will usually pass spontaneously(within 4 weeks)

56
Q

Mx of renal stones < 2cm in aggregate

A

Shockwave lithotripsy

57
Q

Mx of renal stones < 2 cm in pregnant females

A

Ureteroscopy

58
Q

Mx of complex renal calculi and staghorn calculi

A

Percutaneous nephrolithotomy

Gen surg (24 decks)

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