Urinary incontinence Flashcards
What initial investigations are recommended for urinary incontinence?
Initial investigations include bladder diaries for a minimum of 3 days, vaginal examination, urine dipstick and culture, and urodynamic studies.
What management is recommended for urge incontinence?
Management includes bladder retraining for a minimum of 6 weeks and bladder stabilising drugs, with NICE recommending oxybutynin, tolterodine, or darifenacin.
What should be avoided in frail older women for urge incontinence?
Immediate release oxybutynin should be avoided in frail older women.
What alternative medication may be useful for urge incontinence in frail elderly patients?
Mirabegron, a beta-3 agonist, may be useful if there are concerns about anticholinergic side effects.
What management is recommended for stress incontinence?
Management includes pelvic floor muscle training, surgical procedures like retropubic mid-urethral tape procedures, and duloxetine for women who decline surgery.
What is the mechanism of action of duloxetine?
Duloxetine increases synaptic concentration of noradrenaline and serotonin within the pudendal nerve, enhancing contraction of urethral striated muscles within the sphincter.
What is benign prostatic hyperplasia (BPH)?
BPH is a common condition seen in older men.
What are the risk factors for BPH?
Age, ethnicity.
Around 50% of 50-year-old men will have evidence of BPH; around 80% of 80-year-old men have evidence of BPH. Ethnicity risk: black > white > Asian.
What are the voiding symptoms of BPH?
Weak or intermittent urinary flow, straining, hesitancy, terminal dribbling, incomplete emptying.
What are the storage symptoms of BPH?
Urgency, frequency, urgency incontinence, nocturia, post-micturition dribbling.
What are the complications of BPH?
Urinary tract infection, retention, obstructive uropathy.
What assessments are used for BPH?
Dipstick urine, U&Es, PSA, urinary frequency-volume chart, International Prostate Symptom Score (IPSS).
What does the IPSS score indicate?
Severity of lower urinary tract symptoms (LUTS).
Score 20-35: severely symptomatic; Score 8-19: moderately symptomatic; Score 0-7: mildly symptomatic.
What are the management options for BPH?
Watchful waiting, alpha-1 antagonists, 5 alpha-reductase inhibitors, combination therapy, antimuscarinic drugs, surgery.
What are alpha-1 antagonists used for in BPH?
They decrease smooth muscle tone of the prostate and bladder.
First-line treatment for moderate-to-severe voiding symptoms (IPSS ≥ 8), improving symptoms in around 70% of men.
What are the adverse effects of alpha-1 antagonists?
Dizziness, postural hypotension, dry mouth, depression.
What do 5 alpha-reductase inhibitors do?
They block the conversion of testosterone to dihydrotestosterone (DHT), which induces BPH.
When are 5 alpha-reductase inhibitors indicated?
If the patient has a significantly enlarged prostate and is at high risk of progression.
What are the adverse effects of 5 alpha-reductase inhibitors?
Erectile dysfunction, reduced libido, ejaculation problems, gynaecomastia.
What is the benefit of combination therapy for BPH?
Supported by the MTOPS trial and NICE for bothersome moderate-to-severe voiding symptoms and prostatic enlargement.
What should be tried if storage and voiding symptoms persist after alpha-blocker treatment?
An antimuscarinic (anticholinergic) drug such as tolterodine or darifenacin.
What is TURP?
Transurethral resection of prostate, a surgical option for BPH.
What is urinary incontinence (UI)?
Urinary incontinence (UI) is a common problem affecting around 4-5% of the population, more common in elderly females.
What are the risk factors for urinary incontinence?
Risk factors include advancing age, previous pregnancy and childbirth, high body mass index, hysterectomy, and family history.
What are the classifications of urinary incontinence?
Classifications include overactive bladder (OAB)/urge incontinence, stress incontinence, mixed incontinence, overflow incontinence, and functional incontinence.
What characterizes overactive bladder (OAB)/urge incontinence?
It is due to detrusor overactivity, where the urge to urinate is quickly followed by uncontrollable leakage ranging from a few drops to complete bladder emptying.
What is stress incontinence?
Stress incontinence involves leaking small amounts of urine when coughing or laughing.
What is mixed incontinence?
Mixed incontinence is a combination of both urge and stress incontinence.
What is overflow incontinence?
Overflow incontinence is due to bladder outlet obstruction, such as prostate enlargement.
What is functional incontinence?
Functional incontinence occurs when comorbid physical conditions impair the patient’s ability to get to a bathroom in time.
What are some causes of functional incontinence?
Causes include dementia, sedating medication, and injury/illness resulting in decreased ambulation.
What initial investigations are recommended for urinary incontinence?
Initial investigations include completing bladder diaries for a minimum of 3 days, vaginal examination, urine dipstick and culture, and urodynamic studies.
What management is recommended if urge incontinence is predominant?
Management includes bladder retraining, bladder stabilising drugs (antimuscarinics), and mirabegron if there are concerns about anticholinergic side effects.
What is the recommended duration for bladder retraining?
Bladder retraining should last for a minimum of 6 weeks.
What antimuscarinics are recommended by NICE?
NICE recommends oxybutynin (immediate release), tolterodine (immediate release), or darifenacin (once daily preparation).
What management is recommended if stress incontinence is predominant?
Management includes pelvic floor muscle training, surgical procedures, and duloxetine if surgical procedures are declined.
What is the recommended pelvic floor muscle training regimen?
At least 8 contractions performed 3 times per day for a minimum of 3 months.
What is duloxetine and its mechanism of action?
Duloxetine is a combined noradrenaline and serotonin reuptake inhibitor that increases synaptic concentration of noradrenaline and serotonin within the pudendal nerve, enhancing contraction of urethral striated muscles.
