Urinary Incontinence Flashcards
What happens to incontinence if you have a lower motor lesion?
Lesion S2-S4
Low destusor pressure
Large residual urine +/- overflow incontinence
Reduced Perianal sensation
Lax anal tone
What happens to your bladder of you have an upper motor neurone lesion?
Thick bladder
Detrusor sphincter dyssynergia
Dilated ureters
High pressure detrusor contractions
Poor coordination with sphincters
What are the symptoms of lower urinary tract infections?
Storage - Frequency, Uregency, Nocturia, Incontinence
Voiding - Slow stream, Splitting or spraying, intermittency, Hesitancy, Straining, Terminal dribble
Post-mictruition - post-micturition dribble, feeling of incomplete emptying
What are the types of incontinence?
Stress Urinary Incontinence -involuntary leakage on effort or exertion or on sneezing or coughing
Urge Urinary Incontinence - involuntary leakage accompanied by or immediately preceding urgency
Mixed Urinary Incontinence
Overflow Incontinence
What type of incontience is most common?
Stress - 47%
What are the risk factors fo incontinence?
Pregnancy and childbirth
Pelvic surgery
Pelvic prolapse
Race
Family predisposition
Anatomical abnormalities
Neurological abnormalities
Co-morbidities Obeisity Age UTI Drugs Menopause Increased intraabdominal pressure Cognitive impairment
What exams do you do if patient comes in with UI?
BMI
Abdominal exam to exclude palpable bladder
Digital rectal exam - prostate, limited neurological
Females - external genitalia (stress test), vaginal exam
What investigations are done if a patient comes in with UI?
Urine dipstick - UTI, haematuria, proteinurea, glucosuria
Non-invasive urodynamics - frequency-volume chart, Bladder diary (>3 days), Post-mictruition residual volume - in patients with voiding dysfunction
Optional - Invasive Urodynamics (pressure-flow studies), Pad tests, Cystoscopy
What conservative managements can be done fro people with UI?
Modify fluid intake Weight loss Stop smoking Decrease caffeine intake Avoid constipation Decrease fizzy drinks Timed voiding - fixed schedule
Contained incontinence?
Indwelling catheter - Urethral or suprapubic (mortality associated with suprapubic)
Sheath device - analogous to an adhesive condom attached to catheter tubing and bag
Incontinence Pads
How do you manage stress UI?
Pelvic floor muscle training: 8 contractions 3x a day, at least 3 month duration
Pharmacological:
-Duloxetine -combined, noradrenaline and SSRI, increases the activity in striated sphincter during filling phase.
Surgery for Females:
Permanent intentions - Low-tension vaginal tapes (commonest), Open retropubic suspension procedures, classical sling procedures.
Temporary (more pregnancies) - Intramural bulking agents
Surgery for Males:
Artificial urinary sphincter
Male sling procedure
What are low tension vaginal tapes?
Supports mid-urethra Polypropylene mesh
Minimally invasive techniques
- Tension free vaginal tape (TVT)
- Transobturator tape (TOT)
Success rate = over 90%
What surgical procedures can be done to rectify UI?
Retropubic suspension procedures - correct anatomical position of proximal urethra and improve urethral support.
Classical fascial sling procedures - Supports the urethra and augments bladder outflow resistance.
Male artificial urinary sphincter - gold standard
Urethral sphincter deficiency - neurological, post-DXT or surgery
Cuff simulates action of normal sphincter to circumferentially close the urethra
Mechanical (hydraulic) decide
What surgery can be conducted to temporarily fix urinary incontinence?
Intramural bulking agents.
These improve the ability of the urethra to resist abdominal pressure by improving urethral computation.
Have injections under anaesthetic (local or general)
How do you manage urgency uninacy incontinence initially?
Bladder training - schedule of voiding.
Conservative management.
