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Y3 Conditions > Urinary incontinence > Flashcards

Urinary incontinence Flashcards

1
Q

Urinary Incontience

What type of nervous supply do the ureters receive?

A

autonomic

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2
Q

Urinary Incontience

What type of nerve supply does the bladder have?

A

autonomic

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3
Q

Urinary Incontience

Describe the muscle types and of the two sphincters in the urethra. (female)

A

internal urethral sphincter -> thickening of detrusor muscle, smooth muscle, involuntary control

external urethral orifice -> skeletal muscle, voluntary control

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4
Q

Urinary Incontience

define normal miturition

A

the intermittent voiding of urine stored in the bladder

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5
Q

Urinary Incontience

What are the two phases of micturition?

A

filling
voiding

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6
Q

Urinary Incontience

Expand on the processes of the filling and voiding phases of miturition.

A

Filling:
- bladder fills and distends without rise in intravesical pressure
- urethral sphincter contracts and closes urethra

Voiding:
- bladder contracts and expels urine
- urethral sphincter relaxes and urethra opens

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7
Q

Urinary Incontience

Compare adult and infant micturition

A

infants: local spinal reflex (bladder empties of reaching critical pressure)

adults: voiding can be initiated or inhibited by higher centre control of the external urethral sphincter

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8
Q

Urinary Incontience

What receptors are stimulated as the bladder fills? What spinal nerves do these correspond to? What do these spinal nerve release to bind to the receptors in the bladder?

A

M3 receptors
parasympathetic S2-4
ACh

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9
Q

Urinary Incontience

What happens when the M3 receptors of the bladder become stretched and stimulated?

A

contraction of detrusor muscle for urination

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10
Q

Urinary Incontience

How do the parasympathetic nerve fibres work on the internal urethral sphincter while the detrusor muscle contracts?

A

inhibit internal urethral sphincter -> relaxation -> bladder empties

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11
Q

Urinary Incontience

Once the bladder empties and the stretch fibres of the bladder become inactivated, ______ nervous system (T__- L__) is stimulated by to activate the ____ receptors with _____, causing _____ of the detrusor muscle so that the bladder can fill again

A

sympathetic
T11-L2
beta 3 receptors
noradrenaline
relaxation

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12
Q

Urinary Incontience

Define stress urinary incontinence.

A

complaint of involuntary leakage on effort or exertion, or on sneezing or coughing

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13
Q

Urinary Incontience

Is stress urinary incontinence common?

A

yes

up to 40% of women experience

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14
Q

Urinary Incontience

What are some common causes of stress urinary incontinence?

A
  • Sphincter deficiency
  • Urethral hypermobility
  • Prostatectomy in men
  • Pelvic weakness
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15
Q

Urinary Incontience

Name some risk factors for stress urinary incontinence.

A
  • Pregnancy/childbirth.
  • Age/menopause.
  • Obesity.
  • Constipation.
  • Pelvic organ prolapse.
  • Chronic cough/smoking.
  • Excessive weight lifting.
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16
Q

Urinary Incontience

Which investigations should be carried out with pts who have stress urinary incontinence?

A
  • Urine dipsticks and cultures (exclude any infection)
  • Creatinine and blood urea nitrogen (BUN) (assess kidney function)
  • pad test (amount of urine leaked can be quantified)

A full neurological, vaginal and rectal examination should also be carried out to detect any possible cause for the incontinence e.g. prolapse.

17
Q

Urinary Incontience

What is the pathology of stress urinary incontinence?

A

impaired bladder and urethral support and impaired urethral closure

18
Q

Urinary Incontience

Define overactive bladder (urge urinary incontinence).

A

urinary urgency with urinary frequency and nocturia with or without urgency urinary incontinence

19
Q

Urinary Incontience

How can we investigate for stress urinary incontinence?

A

history + examination (demonstrable loss of urine on examination)

urodynamics (urinary leakage during an increase in intrabdominal pressure in the absence of a detrusor contraction

20
Q

Urinary Incontience

How can we manage stress urinary incontinence (conservatively)?

A

lifestyle: losing weight, reducing caffeine intake and stopping smoking

physio with PFE

21
Q

Urinary Incontience

How can we manage stress urinary incontinence (prescribing)?

A
  • alpha-adrenergic agonists
  • oestrogen (topically in postmenopausal women with vaginal atrophy)
  • tricyclic anti-depressants
22
Q

Urinary Incontience

How can we manage stress urinary incontinence (surgically)?

A

surgical:
- mid-urethral sling or colposuspension (these 2 to reduce mobility of urethra)
- periurethral bulking agents (if we believe sphincter not working properly)

23
Q

Urinary Incontience

Explain urodynamics. How can we use it to diagnose urinary stress incontinence?

A

24 hr test
- urinary catheter is inserted into bladder with a thin pressure line next to it with another thin pressure line in the rectum
- measurements of bladder pressures and indirect abdominal pressures.

  • ask patient to cough and you will see a rise in intrabdominal pressure, but no contraction of detrusor associated with urinary leakage
24
Q

Urinary Incontience

Name some risk factors of urge urinary incontinence

A

age
prolapse
increased BMI
bladder irritants (caffeine, nicotine)

25
Q

Urinary Incontience

Describe the pathophysiology of urge urinary incontinence.

A
  • involuntary detrusor muscel contraction
  • can be idiopathic, neurogenic, bladder outlet obstruction or other
  • in general not well understood yet
26
Q

Urinary Incontience

Investigation of overactive bladder?

A
  • exclude infection
  • voiding diaries (3 day charts)
  • assess post void residual
  • urodynamics
  • cystoscopy
27
Q

Urinary Incontience

Management of overactive bladder?

A

no cure

28
Q

Urinary Incontience

Describe what a voiding diary is. Why do we use it?

A

Can be used to investigate overactive bladder

a 3 day chart

29
Q

Urinary Incontience

Why are antimuscarinic drugs used as a treatment for urge urinary incontinence?

A

M3 receptors on detrusor muscle are activated by ACh from parasympathetic fibres

bladder contracts

block the receptors and ACh can’t bind and less contraction of detrusor -> bladder

30
Q

Urinary Incontience

If patients can’t tolerate antimuscarinic drugs as a treatment for urge urinary incontinence, what else can be used?

A

beta-3-agonists

beta-3 receptors which facilitate detrusor muscle relaxation

31
Q

Urinary Incontience

How does BOTOX work as a treatment for urge urinary incontinence?

A

stops ACh release and temporarily (6-9mon) stops detrusor muscle contraction

32
Q

Urinary Incontience

What nerves are targeted for neuromodulation when treating urge urinary incontinence?

A

PTNS - posterior tibial nerve (brand from S2,3,4)
SNS - sacral nerves (S3)

33
Q

Urinary Incontience

What is overflow incontinence? What is is usually caused by?

A
34
Q

Urinary Incontience

What is continuous incontinence? What can it be caused by?

A
35
Q

Urinary Incontience

What is functional incontinence? What can it be caused by?

A
36
Q

Urinary Incontience

What is it caused when there is more than one type of incontinence involved?

A

mixed

Y3 Conditions (55 decks)

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