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SM Renal > Urinary Incontinence > Flashcards

Urinary Incontinence Flashcards

1
Q

What is urinary incontinence

A

The complaint of any involuntary leakage of urine

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2
Q

What are the 4 different types of urinary incontinence

A

Overflow
Urge
Stress
Mixed

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3
Q

In what 2 ways could urine leak by an extraurethral route

A

Ectopic ureter

Fistula

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4
Q

In normal physiology, describe the difference in pressure between the intravesical pressure and the urethral pressure during the storage phase

A

The intravesical pressure is less than the urethral pressure so urine stays in the bladder during the storage phase

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5
Q

In normal physiology, describe the difference in pressure between the intravesical pressure and the urethral pressure during the voiding phase

A

Increased intravesical pressure exceeds the urethral pressure allowing flow to occur

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6
Q

Why do we not use urodynamics unless we absolutely have to

A

Invasive test

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7
Q

What does urodynamics allow us to do

A

Understand the changing pressures around the bladder

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8
Q

What do we ask the patient to do during urodynamics

A

Cough 3 times with increasing pressure levels

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9
Q

Why do we get the patient to cough in urodynamics

A

To increase the abdominal pressure

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10
Q

What are the 4 main components of the micturition reflex

A

Brain
S2,S3
Spinal Bladder Centre
Bladder and Sphincters

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11
Q

Why do reflexes happen without you thinking about them

A

Because the afferent fibre in the spinal cord is allowed to fire off the reflex

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12
Q

What happens in the spinal reflex arc in terms of over riding the micturition reflex

A

There is an inhibitory signal that goes to down to the reflex centre and switches off the reflex

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13
Q

What is the underlying cause of overflow incontinence

A

An overflowing bladder due to an obstruction

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14
Q

Describe some symptoms and signs of a patient with overflow incontinence

A

Huge palpable bladder
Chronic retention
Insensible incontinence
Often wet at night

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15
Q

What is urge incontinence part of

A

Urge syndrome

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16
Q

Describe the signs and symptoms of urge syndrome

A 
Frequency 
Small voided volumes 
Urgency 
Provocation e.g. key in the door, sound of running water, standing up, coughing, laughing 
Enuresis 
Urge urinary incontinence
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17
Q

How is detrusor overactivity diagnosed

A

by urodynamics

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18
Q

What happens to the detrusor muscle that causes bladder dysfunction

A

It contracts during inhibition of voiding

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19
Q

Describe the findings of detrusor overactivity on urodynamics

A

The bladder will not fill as much as a normal patient before getting an urge.
When the patient coughs, on coughing, (i.e. increasing the intra-abdominal pressure) the intravesical pressure will increase and remain at a higher pressure compared to a normal person on the final cough
Some patients cannot hold on and will leak urine

Involuntary contraction of the detrusor muscle

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20
Q

What might be the underlying problem for patients with urge incontinence

A

Irrotation in the bladder
(Irritation in the sensory organ of the reflex arc)
such as bladder stone, bladder tumour or an excess stimulation of the afferent arc of the reflex

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21
Q

What is meant by paraplegia and how does this affect the bladder

A

Loss of central inhibition e.g. spinal injury

The bladder will fill and kick off and empty itself in paraplegia

22
Q

Where is the commonest site of a spinal injury

A

Down at the lumbar level - i.e. close to S2,S3

23
Q

What happens if there is destruction of S2-3 centre

A

Bladder becomes an inert bag

24
Q

How does the detrusor muscle become an inert bag when there is a spinal cord injury

A

The reflex is turned off and so no muscle activity occurs. Therefore the bladder fills up and flows freely

25
Q

What population may be affected by idiopathic detrusor overactivity

A

Middle aged women

26
Q

What are the symptoms of idiopathic detrusor overactivity

A

Frequency and urgent incontinence

27
Q

What happens in stress incontinence

A

urine leaks during increased intra-abdominal pressure without a detrusor contraction
Cough, sneeze etc.

28
Q

What often causes stress incontinence

A

Damage to pelvic floor or urethral function - childbirth

29
Q

How is a diagnosis of stress incontinence made

A

Urodynamics

30
Q

Describe what is seen in urodynamics in stress incontinence

A

As the bladder volume increases, leakages become bigger
Destrusor has normal activity
Cough causes a leak without a detrusor contraction

31
Q

Why do patients with stress incontinence go to the toilet more frequently

A

They know that they will get less leakage if they void more often

32
Q

On examination, how can we tell that we are examining the bladder

A

It is a painless palpable mass that arises from the bladder
We cannot “get below” it
Dull to percuss

33
Q

What is the treatment for overflow urinary retention

A

Catheterise the patient and then try to rehabilitate the bladder
Some patients will self catheterise

34
Q

What happens to the bladder in overflow urinary incontinence

A

It is chronically stretched leaving a bigger and bigger residual flow every time they go tot eh toilet

35
Q

What is some advice you can give a patient with urge urinary incontinence

A 
Dietary discretion (avoid caffeine) 
Bladder retraining - time bladder emptying
36
Q

What drugs can be given for urge urinary incontinence

A

Antimuscarinics e.g. oxybutynin, tolterodine

Beta 3 adrenergic e.g. mirabegron

37
Q

What surgical procedure can be done for urge urinary incontinence

A

Enterocystoplasty

Open up the bladder and add a patch of bowel to it - this drastically helps the incontinence

38
Q

What is a side effect of an antimuscarinic

A

Makes the mouth dry - patients want to drink more - more urine output

39
Q

What are the conservative management options for stress incontinence

A

Weight loss
stop smoking
pelvic floor exercises (physio)

40
Q

What drug can be used occasionally for stress incontinence

A

Duloxetine

41
Q

What surgical procedures can be performed for stress incontinence

A

Open procedure - colposuspension but now more often it is the minimally invasive “tape” procedure

42
Q

What is meant by mixed incontinence

A

A combination of urge and stress therapies

43
Q

What is the treatment for mixed incontinence

A

Lose weight
stop smoking
less caffeine
Surgery

44
Q

What factors can result in urinary incontinence in the elderly

A 
Immobility 
Dementia 
Drugs - diuretics, sedatives 
obstruction (prostate benign hyperplasia) and overflow 
neuropathy 
pelvic floor weakness
45
Q

In what other ways may urine be lost from the bladder

A

Ectopic ureter

Fistula

46
Q

How does an ectopic ureter arise and how does it cause incontinence

A

It is congenital

It bypasses the sphincter meaning that urine can flow freely

47
Q

Why is a vesico-vaginal fistula more common in developing countries

A

Prolonged obstructed labour causing holes in the bladder

48
Q

What is the definition of urgency

A

The complaint of a sudden compelling desire to pass urine which is difficult to deter

49
Q

What are some voiding symptoms that a patient may complain of

A 
Slow stram 
splitting 
spraying of the urinary stream 
hesitancy 
straining
50
Q

What does a frequency volume chart (FVC) do

A

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

SM Renal (23 decks)

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