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Renal > Urinary incontinence > Flashcards

Urinary incontinence Flashcards

1
Q

Types of unrinary incontincence

A

Stress urinary incontinence

Urge incontinence

others : high pressure chornic retention, post-micturition dribble, contant leaking

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2
Q

Stress urinary incontinence

A
  • as a result of hypermobility, and neuromuscular problems that causes weak internal sphincter, wehn abdominal pressure increases anf the stability of the urethra decreased
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3
Q

Urge incontinence

A

leakade accompanied or immediately preceded by urgency

overactive bladder /detrussre instability or due to a pathology

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4
Q

High pressure chronic retention

A

on sleeping the pressure in the baldder overtakes the sphincter continence and bed wetting

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5
Q

Post-micturition dribble

A

prostate enlarges, sits in the bulbar urethra and comes out

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6
Q

Constant leak of urine

A

Fistula - in women with pelvic surgery/ bladder damage during hysterectomy

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7
Q

Little girl always dribbling the whole time

A

ectopic ureter –> opens into the proximal urethra or vagina –> needs surgery to re-implant it

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8
Q

Micturition cycle problems from the brain

A

Thalamus, scaral micturition centre, diabetic damage to periphersl nerves, cerebral lesions, micturition centre in the forntal lobe,

bladder - hypotonic (high pressure bladder developed and the bladder contracts repeatedly and empties constantly)

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9
Q

Who is it more common in?

A

Women –> Causcasian > Afro-carribeans

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10
Q

Bladder extrophy

A

front of the pelvis doesnt close properly and the bladder is open on the surface

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11
Q

Risk factors

A

fistula, ectopic ureter in girls, urehtral diverticulum, urethral fistula, surgeries, child birth

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12
Q

Risk factors

A 
smokin - causing cough
obesity
infection - UTO
poor nutrition
ageing
cognitive defect
poor mobility
oestrogen deficiency
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13
Q

History in urinary incontincence

A 
Type 
Triggering factors
frequency
defree of bother
risk factors
sense of something coming down (prolapse)
Red flags:
painful micturition, haematuria, recurrent UTI, significant vioding
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14
Q

Physical exam women

A

Chaperone
lie down

as them to cough, look for bladder dripping, examine abdomen for palpable bladder, pelvic exam to asses floor muscle strength, bladder neck mobility, vulva for oestrogen deficiency in older women

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15
Q

Physical exam both sexes

A

abdomen fro palpable bladder

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16
Q

Basic investigation

A

Bladder diary - frequency, timing and how much they drink
urinalysis - +/_ culture
flow rate and post-void residue
pad testing

normal void - men 25/30 mls per sec
(bell shaped curved)

women - faster as the urethra is shorter

Renal function
Blood tests
imaging
cystoscopy

17
Q

Cystometry

A

overactive bladder or for surgeries

2-way catheter - one for water and the other for pressure (detrssur pressure)

rectum - to remove the artefact (subtracts abdominal pressure)

ask them when they feel the urge to void and stuff

18
Q

Cystometry actiity

A

no detrusser activity on filling

overactive bladder- reaches 200 mls and they can’t hold on and have to pee

19
Q

What is the conservative treatment?

A

pelvic floor exercises - pelvic floor exercises, needs to be practiced all the time to maintain the benefit

lifestyle modification- weight loss, stop smoking, modify fluid intake

biofeedback - instrument that gives you a visual/ auditory feedback as to which mucle you should strengthen and train

muscle - duloxetine - increase sphincter activiyt, but doesnt work that much

Electrical stimulation of the pelvic flood - not that helpful

20
Q

Surgical treatment

A

inject bulking materials submucosally - > to increase resistnace, in women esp in stress incontinence, silicon or teflon pastes

21
Q

contraindications for surgery

A

UTI, untreater bladder overactivitiy (dont want to increase their outflow resistance), bladder neck stenosis

22
Q

What is retropubic suspension?

A

to treat -female stress oncontinence, hypermobile urethra

lift and fix to-a retro0urethral position

Bursch col- suture vagina on either side of the urethra and attach it to the lateral pelvic wall - suspend the bladder neck and urethra
succes rate - 70%

23
Q

Suburethral tapes and slings

A

recent
pelvic pain associated
complications
insicionin the vagine, anterior under the urethra to push up either end of the bladder and attach it to the lower end of the abdominal wall and tight it

support the urethra for those with intrisic sphincter deficiency

24
Q

pubovaginal sling

A

wih rectal fascia

25
Q

Artificial urinary sphincter

A

implant
more in men

balloon, pump and cuff
ballon in the iliac fossa, cuff around urethra, pump in scrotum, when full man pumps, moves the the fluid to balloon and deflateds the cuff. the cuff automatically refills in 3min

can get urethral atrophy and stuff

26
Q

Overactive ballder

A

urgency and mostly with urge incontinence usually with frequency and nocturia

27
Q

management for overactive bladder

A

Pelvic floor exercises
behaviour modification –> cut out caffeine and alcohol
modify fluid intake - try to hold on or 5 min, then 10 min –> densensitise bladder over the course of the time
acupuncture and electrical stimulation

28
Q

anticholinergic medication (antimuscarinin)

A

helps to contol the derusser

side effects - dry mouth, GORD, constipation, cognitive impairement, anti-cholinergic burden in the elderly

immediate release oxybutynin - not that good so try to reduce the frequency of using it

29
Q

Contra-indication for anti-cholinergics

A

anrrow angles galucoma, myasthenia gravis, UC

30
Q

B-aginists

A

helps increase bladder capacity without changing bthe pressure or volume

contraindication - uncontrolled hypertension

31
Q

Intravesical botulinium toxin

A

botox paralyses the detrusser muscle and stops the over activity

but they might not be able to void for 2-3 weeks so they need to be ready to self-catheterise, and do this 2-3 times per year

32
Q

neuromodulation

A

sacral nerve stimulation involved electrical stimulation of the baldder’s nerve supply to suppress reflexes responsible for involuntary detrusser contraction

external device that can stimulate the S3 afferent nerve at the level of the sacral spinal cord

33
Q

Clam ileocystoplasty

A

intractable incontinence, and have tried everything else, change in bowel habit, urge and UUI in patients

patient has an operation to bivalve the bladde to make it into 2 flaps, thus it destroys the bladders ability to contract and squeeze down with as much pressure as before

take the mesentery of SI, flap of mesentery with blood supply and suture it on the bladder

complications - mucus in bladder

34
Q

Ileal conduit urinary diversion

A

last resort, those who have hadradiotherapy to the pelvic

instead of indwelling catheter

ureter disconnected, ureter then sutured to the ileum and then to a stoma and outside

Renal (21 decks)

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