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Renal SB > Urinary Incontinence > Flashcards

Urinary Incontinence Flashcards

1
Q

what is definition of urinary incontinence

A

complaint of any involuntary leakage of urine

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2
Q

what are the types of urethral incontinence

A

Overflow incontinence
Urge incontinence
Stress incontinence
Mixed incontinence

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3
Q

what can cause urine to leak extraurethral

A

ectopic ureter

fistula

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4
Q

what happens in the storage phase

A

Intravesical pressure is less than the urethral pressure

Urine stays in bladder

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5
Q

what can affect urethral pressure

A

abdominal pressure

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6
Q

what happens in the voiding phase

A

active contraction of the detrusor muscle - increases intravesical pressure
exceeds urethral pressure
flow occurs

co-ordinate relaxation of the bladder outlet

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7
Q

what spinal level is the bladder centre

A

S2-S3

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8
Q

what nerves play a part in the reflex arcs of the bladder

A

pelvic parasympathetic nerves

pudendal nerve

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9
Q

what are features of overflow incontinence

A

Huge palpable bladder
Chronic retention
Insensible incontinence (no signal they are going to lose control)
Often wet at night

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10
Q

what often causes outflow incontinence

A

bladder outflow obstruction

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11
Q

what can be a consequence of continued bladder outflow obstruction

A

renal failure/impairment

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12
Q

what is the features of urge syndrome

A 
Frequency, small voided volumes
Urgency
- Provocation
Enuresis
Urge urinary incontinence (do not make it to the toilet on time)
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13
Q

how is detrusor overactivity diagnosed

A

urodynamics

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14
Q

what is detrusor overactivity

A

Bladder dysfunction characterised by detrusor contractions occurring during inhibition of voiding

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15
Q

what can irritate the bladder and cause afferent overstimulation

A

bladder stone

bladder tumour

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16
Q

what happens in paraplegia in relation to urinary incontinence

A

loss of central inhibition

17
Q

what spinal injury causes the bladder to become an inert bad

A

destruction around the lumbar region, S2 and S3

18
Q

what can damage the parasympathetic nerves around the bladder

A

pelvic surgery or fracture

19
Q

what is (Urodynamic) Stress incontinence

A

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

20
Q

causes of USI

A

damage to pelvic floor or urethral function - childbirth

21
Q

how is USI diagnosed

A

urodynamic diagnosis

22
Q

what would be seen on Examination of an overflow urinary incontinence

A 
Painless palpable mass
arising from pelvis
Cannot “get below” it
Dull to percussion
=bladder
23
Q

Tx of overflow urinary incontinence

A

Assess renal function
Treat the obstruction
- Catheterise

Rehabilitate the bladder
- Teach intermittent self catheterisation

24
Q

Tx of urge urinary incontinence

A

Dietary discretion (avoid caffeine)
Bladder retraining,
Antimuscarinics - (e.g. oxybutynin, tolterodine)
Beta 3 adrenergics (mirabegron)
Neuromodulation (“pacemaker” for the bladder)
Surgery - Enterocystoplasty

25
Q

what is a Side effect of antimuscarinics

A

dry mouth

26
Q

Tx of stress incontinence

A 
Stop smoking!
Pelvic floor exercises - physiotherapy
Weight loss
Surgical correction
- Open procedures – colposuspension
- largely replaced by:
Minimally invasive “tape” procedures
27
Q

what are the factors of urinary incontinence in the elderly

A 
Immobility
Dementia
Drugs- diuretics, sedatives
Obstruction and overflow
Neuropathy
Pelvic floor weakness
28
Q

what is a ectopic ureter

A

rare, congenital

ureter is joining with urethra below bladder

29
Q

when should ectopic ureter be considered

A

baby that cannot get out of nappies

child is developing normal but urine is leaking continuously

30
Q

what is vesico-veginal fistula

A

vagina and bladder touching causes ischaemia
fistula is made
urine leaks out

seen in developing countries

31
Q

definition of stress urinary incontinence

A

involuntary leakage on

effort or exertion, or on sneezing or coughing

32
Q

definition of urgency

A

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

33
Q

definition of urgency urinary incontinence

A

involuntary leakage accompanied by, or immediately preceded by urgency.

34
Q

Urgency, with or without urge incontinence, usually with frequency and nocturia - what is this?

A

overactive bladder syndrome, or urge syndrome

Renal SB (15 decks)

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