Urinary Incontinence Flashcards
Classification:
Stress UI: on effort or exerion (dt urethral sphincter weakness)
Urge UI: accompanied by, or immediately preceded by a strong desire to pass urine.
Mixed UI
Overflow incontinence: Bladder becomes large and flaccid and has little or no detrusor tone.
continuous UI: associated with fistula or congenital abnormality
Other types of incontinence:
Incontinence arising from UTIs, medications, immobility, or cognitive impairment.
situational Incontinence e.g. giggle Incontinence.
Urgency with or without urge urinary Incontinence, usually with frequency and nocturia:
Ovaractive bladder syndrome (OAB)
Involuntary leakage of urine during increased intra-abdominal pressure in the absence of detrusor contractions
Urodynamic stress incontinence (USI)
Unlike stress urinary incontinence, urodynamic stress incontinence can only be diagnosed by:
Urodynamic testing
The most common caustive factor of SUI in women
Childbirth: leading to denervation of the pelvic floor
Other causes of SUI
• estrogen deficiency at time of menopause lesd to weakening of pelvic support and **thinning of urothelium
• weakness of the bladder neck can occur congenitally, or through trauma from radical pelvic surgery or irradiation
CF of SUI:
Symptoms:
Leakage of urine on cough …etc
Sighs:
Prolapse of the urethra and anterior vaginal wall (may be)
Ask woman to cough with fairly full bladder
Pharmacological management of SUI
Duloxetine : moderate to severe
SE: nausea, dry mouth, dyspepsia
Surgical management of SUI:
A. Peri-urethral bulking injections
B. Colposuspension:
• Tension-free vaginal tape (TVT)
• Transobturator tape (TOT)
• Burch colposuspension
• Laproscopic colposuspension
Complications of TVT:
Infection
Bleeding jn retropubic space
Bladder injuries, voiding difficulties
Tape erosion into the vagina and urethra
The main difference between TVT & TOT
In TOT: the retropubic space is not entered, and the risk of bladder perforation is low.
Disadvantages of transobturator slings:
Higher risk of nerve trauma, with chronic groin pain
Complications of burch colposuspension:
Hemorrhage
Injuries to the bladder
Voiding difficulties de-novo detrusor overactivity
Enterocele or rectocele formation
