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3B week 4 - haematuria etc. > urinary incontinence > Flashcards

urinary incontinence Flashcards

1
Q

what is incontinence

A

involunatry loss of urine/stool in suffiecient amount or frequency to constitute a social/health problem

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2
Q

urinary incontinence epidemiology

A
  1. more prevelent in women
  2. bimodal age distrubition with peaks at 50-55yro (menopaurse) and then 75+
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3
Q

what are the 7 types of incontinence

A
  1. stress
  2. urge
  3. mixed
  4. overflow/nocturnal enuresis
  5. functional
  6. continuous
  7. post micturition dribbling
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4
Q

what is urge incontinence

A

the involuntary leakage of urine accompanied by urgency -> sudden compelling desire to void which is difficult to defer

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5
Q

what is stress incontinence

A

involuntary leakage on effort, exertion, sneezing etc. -> caused by weakness of the pelvic floor

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6
Q

what are the 2 phases of the bladder

A
  1. storage phase -> requires compliant bladder, competent bladder outlet and neurological sensory input
  2. voiding phase -> requires contractile detrusor and competent bladder outlet
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7
Q

5 neurological areas involved in bladder functions + what they do

A
  1. cerebral cortex - detection of need to void and initiation of voiding at appropriate time
  2. pontine micturition centre - brainstem, relay centre between brain and spinal chord
  3. sympathetic systhem (T10-L2) -> inhibition of the parasymp., contractino of outflow tract, low pressure storage vessel
  4. parasymathetic systme (S2-S4) -> excitatory to bladder smooth muscle - DETRUCTOR contraction, voiding phase
  5. somatic (S2-4) -> external urethral sphincter contraction, pelvic floor contraction, continence and co-ordinating voiding
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8
Q

what are the 4 parts of the urethra in males

A
  1. prostatic urtehtra
  2. membranous urethra
  3. bulbular urethra
  4. penile urethra
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9
Q

during storage what features does the bladder display (2)

A
  1. compliant (can expand and allow filling)
  2. sensate
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10
Q

during emptying what feature does the bladder display

A

contractile

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11
Q

during storage what feature does the bladder outlet display

A

competent

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12
Q

during emptying what feature does the bladder outlet display

A

relaxation

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13
Q

3 conditions associated with urge incontinence

A
  1. detrusor overactivity
  2. sensory urgency
  3. bladder outlet obstruction
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14
Q

what can cause stress incontience in men (3)

A
  1. TURP
  2. radical retropubic prostatectomy (RRP)
  3. trauma
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15
Q

what can cause stress incontinece in women

A
  1. fascia laxity
  2. ligament weakness
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16
Q

which sex is stress incontinence seen more in

A

women

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17
Q

what is overflow incontinence

A

chronic, painless retention that leads to leaking when relaxed e.g. at night

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18
Q

what might a pt w outflow incontinence complain of

A

having to loosen their belt as they feel like their abdomen is enlarging (due to retention of urine)

19
Q

what is continuous incontinence

A

continuous leakage of urine like a dripping tap -> may be iatrogenic cause

20
Q

what is post-void dribbling usually due to

A

retention in the bulbous urethra -> its like a ‘u bend’ where urine can pool sometimes

21
Q

risk factors for urinary incontinecne (9)

A
  1. women
  2. age
  3. route of baby delivery
  4. pregnancy
  5. obestiy
  6. menopause
  7. smoking
  8. pelvic surgery
  9. bladder outlet obstruction (men)
22
Q

red flags for incontinence (8)

A
  1. Hx of UTI
  2. haematuria
  3. pain
  4. pelvic mass
  5. pelvic radiation
  6. previous surgery
  7. symptomatic prolapse
  8. suspected fistula
23
Q

investigations for urinary incontinence (4)

A
  1. dipstick
  2. voiding diary
  3. flow rate and post void residual
  4. questionnaires
24
Q

what are urodynamics

A

pressure study tests that give info about pressures in the bladder to determine detrusor activity

25
Q

4 levels of continence

A
  1. independent continence (dry without ongoing treatment)
  2. dependednt contrinence (dry with toileting therapy or medication)
  3. contained continence (pads or appliances)
  4. incontinent
26
Q

what causes urge incontinecne

A

detrusor overactivity

27
Q

urge incontinence mgx

A
  1. conservative -> fluid and dietary advice (more water, less caffeine and fizzy drinks), bladder retraining
  2. antimuscarinics
  3. S3 neuromodulation
  4. surgery -> botox, S3 implant, clam cystoplasty
28
Q

how do anti muscarinic agents reduce incontience

A

bind to muscarininc receptors to decrease involuntary detrusor contractions and increase bladder capacity

29
Q

contraindications to anticholinergic drugs (3)

A

1.uncontrolled narrow angle glaucoma
2. myasthenia gravis
3. bowel disorders

30
Q

side effects of antimuscarinic drugs (6)

A
  1. dry mouth
  2. constipation
  3. ophthalamic -> raised IOC, blurred vision, paralysis of accommodation
  4. drowsiness
  5. confusion
  6. tachycardia
31
Q

mirabegron MOA

A

potent and selective agonist of beta-3 adrenergic receptors -> activation of B3Rs leads to relaxation of the smooth muscle of the detrusor muscle during the storage phase -> improved storage capacity and decreases voiding frequency

32
Q

what must be done prior to surgery for incontinence

A

urodynamics to confirm diagnosis

33
Q

what is percutaneous tibial nerve stimulation

A

stimulation of the tibial neve at the medial malleolus -> this is the same nerve root as that which controls the bladder

34
Q

what is sacroneuromodulaton

A

insertion of permanent stimulator in the S3 foramen to control the stimulation of the bladder -> signals bladder to relax the detrusor muscle

35
Q

what is the risk of botox for incontinence treatments and what are patients taught to avoid this

A

risk of complete paralysis of the detrusor muscle leading to complete urinary retention -> pts taught to self catheterise in case

36
Q

female stress incontinence mgx (3)

A
  1. conservative - weight loss, muscle strengthening exercises
  2. duloxetine (not used much anymore)
  3. surgery
37
Q

what surgeries can be done for stress incontinence (3)

A
  1. Injectables (e.g. urethral bulking agent)
  2. Sling Surgery
  3. Colposuspension
38
Q

to whom might injectables (urethral bulking agents) be offered to

A
  1. youngs pts who are yet to have a family
  2. elderly pts who cannot tolerate invasive surgery
39
Q

risks of uritary sling surgery (4)

A
  1. haemorrhage
  2. Retention
  3. Denovo Detrusor overactivity
  4. Erosion of tape
40
Q

what is colposuspension surgery

A

Endopelvic hammock retentioned by sutures between fascia and ligament -> purpose is to suspend the prolapsed urethra so that the urethrovesical junction and proximal urethra are replaced in the abdominal cavity

41
Q

complications of colposuspension surgery (4)

A
  1. Open surgery
  2. Retention
  3. Posterior prolapse
  4. Detrusor overactivity
42
Q

male stress incontinence mgx

A
  1. pelvic floor exercises (taught to men pre-prostate surgery due to significant risk of iatrogenic stress incontinence)
  2. injectables (urethral bulking agents)
  3. male urinary sling
  4. artificial urinary sphincter
43
Q

what must be checked for before catheterisation

A

whether there is an artificial sphincter -> if present the cuff must be deflated prior to catheterisation

3B week 4 - haematuria etc. (5 decks)

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