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Renal > Urinary Incontinence > Flashcards

Urinary Incontinence Flashcards

1
Q 
Frequency, small voided volumes
Urgency
Provocation
Key in the door
Sound of running water
Standing up
Coughing, laughing
Enuresis
A

Urge Urinary Incontinence

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2
Q

Volume of urine produced in urge incontinence?

What may provoke the urge?

A

Small volume produced very frequently

Provocation: key in the door, sound of running water, standing up, coughing, laughing

Enuresis (wetting the bed at night)

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3
Q

Treatment for urge incontinence

A

Dietary discretion (avoid caffeine)
Biofeedback
Bladder retraining, Time bladder emptying
Pharmacotherapy
Antimuscarinics - (e.g. oxybutynin, tolterodine)
Beta 3 adrenergics (mirabegron)
Botulinum toxin injection – unlicenced
Neuromodulation (“pacemaker” for the bladder)
Surgery
Enterocystoplasty

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4
Q

What is urinary incontinence?

A

The complaint of any involuntary leakage of urine

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5
Q

Name 2 ways in which urine may leak by an extraurethral route?

A

Extopic ureter

Fistula

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6
Q

Which pressure is responsible for the voiding phase?

A

Detrusor pressure

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7
Q

Where is the spinal bladder centre?

A

S2-S3

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8
Q

Bladder outflow obstruction

Huge palpable bladder

Chronic retention

Insensible incontinence

Often wet at night

Renal impairment

A

Overflow incontinence

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9
Q

Overflow incontinence

A

Bladder outflow obstruction

Huge palpable bladder

Chronic retention

Insensible incontinence

Often wet at night

Renal impairment

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10
Q

Which type of drug may precipitate urge incontinence?

A

Diuretics

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11
Q

How would you diagnose detrusor overactivity?

A

Urodynamics

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12
Q

What is detrusor overactivity?

A

Bladder dysfunction characterised by detrusor contractions occurring during inhibition of voiding

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13
Q

Causes of detrusor overactivity

A

Afferent overstimulation (e.g. due to irritation in the bladder)

Excess central facilitation

Paraplegia

Destruction of S2-S3 centre

Pelvic surgery/fracture (parasympathetic nerves damaged)

Idiopathic detrusor overactivity

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14
Q

What is (urodynamic) stress incontinence

A

Urine leaks during increased intra abdominal pressure, without a detrusor contraction

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15
Q

Detrusor contraction in (urodynamic) stress incontinence?

A

No

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16
Q

What causes (urodynamic) stress incontinence?

A

Damage to the pelvic floor or urethral function

e.g. child birth

17
Q

How to diagnose (urodynamic) stress incontinence?

A

Urodynamics

18
Q

There is someone with a distended tummy, how do you know its the bladder?

A

Painless palpable mass arising from the pelvis
Cannot “get below it”
Dull to percussion

19
Q

Treatment for overflow incontinence

A 
Assess renal function
Treat the obstruction
Catheterise
rehabilitate the bladder
Teach intermittent self catheterisation
20
Q

Treatment for urge urinary incontinence

A

Dietary discretion (avoid caffeine)
Biofeedback
Bladder retraining, Time bladder emptying
Pharmacotherapy
Antimuscarinics - (e.g. oxybutynin, tolterodine)
Beta 3 adrenergics (mirabegron)
Botulinum toxin injection – (was unlisenced, one now liscenced)
Neuromodulation (“pacemaker” for the bladder)
Surgery
Enterocystoplasty

21
Q

Antimuscarinics you could use in urge urinary incontinence?

A

Oxybutynin

Tolterodine

22
Q

What are oxybutynin and tolterodine?

A

Anti-muscarinics

23
Q

Name a beta 3 adrenergic you could use in urge urinary incontinence?

A

Mirabegron

24
Q

What is mirabegron?

A

A beta-3 adrenergic (you coud use this in urge urinary incontinence)

25
Q

Surgery you might carry out in urge incontinence (very last choice)

A

Enterocystoplasty (allows the bladder to hold more urine)

26
Q

What is duloxetine?

A

Serotonin 5-HT

27
Q

Treatment for stress incontinece

A

Weight loss
Stop smoking!
Pelvic floor exercises - physiotherapy
Pharmacotherapy – (not very much role)

Duloxetine (serotonin (5-HT) and norepinephrine (NE) reuptake inhibitor)
Surgical correction
Open procedures – colposuspension
largely replaced by:
Minimally invasive “tape” procedures
28
Q

What is colposuspension?

A

Putting stitches in to support the neck of the bladder

-very last surgery option for stress incontinence (now been replaced by “tape” procedures)

29
Q

Which non-urethral cause of urinary incontinence should you be aware of in developing countries?

A

Vesico-vaginal fistula

-this is because they have prolonged obstructed labour

30
Q

Voiding symptoms

A

Slow stream
Splitting/spraying of the urinary stream
Hesitancy
Straining

31
Q

What does a frequency volume chart record?

A

Records the volumes voided as well as the time of micturition, day and night for at least 24 hours

32
Q

What is urinary incontinence?

A

Urinary incontinence is the complaint of any involuntary leakage of urine.

33
Q

What is stress urinary incontinence?

A

Stress urinary incontinence is involuntary leakage on effort or exertion, or on sneezing or coughing.

34
Q

What is urgency urinary incontinence?

A

Urgency urinary incontinence is involuntary leakage accompanied by, or immediately preceded by urgency

35
Q

What is urgency?

A

Urgency is the complaint of a sudden compelling desire to pass urine, which is difficult to defer

36
Q

What is over active bladder syndrome/urge syndrome/urgency-frequency syndrome?

A

Urgency, with or without urge incontinence, usually with frequency and nocturia, can be described as overactive bladder syndrome, urge syndrome or urgency-frequency syndrome

37
Q

What is detrusor overactivity incontinence?

A

Detrusor overactivity incontinence is incontinence due to an involuntary detrusor contraction

38
Q

What is mixed urinary incontinence?

A

Mixed urinary incontinence is involuntary leakage associated with urgency and also with exertion- effort, sneezing or coughing.

Renal (44 decks)

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