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Renal > Urinary incontinence > Flashcards

Urinary incontinence Flashcards

1
Q

what in urinary incontinence

A

involuntary leakage of urine

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2
Q

what is stress urinary incontinence

A

leakage on effort or exertion, sneezing or coughing

urine leaks whenever urethral resistance is exceeded by increased abdominal pressure

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3
Q

what causes stress urinary incontinence

A

bladder neck/ urethral hypermobility and/or neuromuscular defects causing intrinsic sphincter deficiency

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4
Q

what muscles aids the action of the external urethral sphincter in women

A

levator ani

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5
Q

what is urge urinary incontinence

A

leakage accompanied by or immediately preceded by urgency

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6
Q

what causes urge urinary incontinence

A 
bladder overactivity (detrusor instability) 
less commonly pathology that irritates the bladder (infection, tumour, stone)
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7
Q

what is mixed urinary incontinence

A

a combination of stress UI and urge UI

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8
Q

what does bed wetting in elderly men indicate

A

high pressure chronic retention

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9
Q

what is post micturition dribbling and what causes it

A

dribbling immediatley after leaving the toilet

due to urine pooling in the bulbar urethra

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10
Q

what does a constant leak of urine suggest

A

fistulas communications between the bladder and vagina (due to surgical injury at the time of hysterectomy or caesarian section)
can also be an ectopic ureter draining into the vagina

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11
Q

what should you suspect in a young girl with a constant leak of urine

A

ectopic ureter (draining into the vagina)

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12
Q

what nerve conditions can cause urinary incontinence

A

cerebral cortex:

  • stroke
  • MS
  • brain injury
  • parkinsons
  • cerebral palsy

spinal cord:

  • lesions
  • trauma
  • spina bifida
  • MS

peripheral nerve damage
-diabetes

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13
Q

where is the sacral mictrurition centre

A

S2-4

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14
Q

what are the risk factors for urinary incontinence

A

female
caucasian
genetic predisposition
neurological conditions
anatomical disorders
child birth (SVD, increasing parity, pregnancy (stress UI)
pelvic, perineal and prostate surgery (radical hysterectomy, prostatectomy, TURP
(causing pelvic muscle and nerve injury or damage to external urethral sphincter)
radical pelvic radiotherapy
diabetes

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15
Q

what anatomical disorders can cause UI

A

vesicovaginal fistula, ectopic ureter (girls), urethral diverticulum, urethral fistual, bladder extrophy,
epispadias

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16
Q

what factors can promote UI

A 
smoking (chronic cough) 
obesity 
infection (UTI)
increased fluid intake 
poor nutrition 
ageing 
cognitive defect 
poor mobility 
oestrogen deficiency
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17
Q

what should you ask in a history of UI

A 
type
triggering factors 
frequency +degree of bother 
RFs
previous surgery 
bowel symptoms 
symptoms of sexual dysfunction/ pelvic organ prolapse on women
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18
Q

what are the red flags in UI

A 
pain 
haematuria 
recurrent UTI
significant voiding/obstructive symptoms 
history of pelvic surgery/ radiotherapy
19
Q

what should you include in a female exam for UI

A

chaperoned pelvic exam
ask patient to cough or strain and look for anterior and posterior vaginal wall prolapse, uterine or vaginal vault descent and urinary leakage

internal pelvic exam to assess voluntary pelvic floor muscle strength and bladder neck mobility

inspect the vulva for oestrogen deficiency (vaginal atrophy)

20
Q

what should you do in both sexes for an exam for UI

A

abdo- palpable bladder (urinary retention)
neurological exam to asses gait, anal reflex, perineal sensation and lower limb function
DRE to exclude constipation, rectal mass and to asses anal tone

21
Q

what are the exam red flags in UI

A

new neurological deficit
haematuria
urethral, pelvic or bladder mass and suspected fistula

22
Q

what investigations into UI

A 
bladder diary (frequency volume chart) 
urinalysis +/- culture 
flow rate 
post void residue (USS)
pad testing

blood tests, imaging, cytoscopy (if suspecting anatomical abnormality or fistula)

23
Q

what will flow rate charts look lik

A

low long curve= BOO
lots of ups and downs= straining, intermittent flow

women flow will be higher than mens due to shorter urethra

24
Q

what is urodynamics

A

2 way catheters that senses both the bladder and abdominal pressure in order to isolate the bladder pressure
(cystometry)

25
Q

what is the conservative treatment for UI

A

pelvic floor exercises (improvement in 30% of women- 8 contraction 3x daily)

weight loss, smoking cessation, avoid constipation, modify fluid intake

biofeedback- ability and strength of pelvic floor contraction is fed back to patients as a visual/ auditory signal

electrical stimulation of the pelvic floor (no proven)

medication

26
Q

what medication for stress UI

A

duloxetine- inhibits re-uptake of both serotonin and noradrenalin (increases sphincteric muscle activity during bladder filling)

27
Q

what is injection therapy for UI

A

injection therapy
-bulking materials (silicone, teflon) injected into bladder neck and periuretheral muscles to increase outlet resistance
(mainly for female SUI secondary to demonstrable intrinsic sphincter deficiency w/ normal bladder muscle function)

aim to achieve urethral mucosal apposition and closure of the lumen

50-80% success but deteriorates with time, repeated treatments often needed

28
Q

what are the indications of injection therapy for UI

A

UTI, untreated bladder overactivity, bladder neck stenosis

29
Q

what are the complications of injection therapy for UTI

A

temporary urinary retention, de novo urge incontinence, UTI, haematuria

30
Q

what is retropubic suspension

A

to treat stress incontinence caused by urethral hypermobility

elevate and fix the bladder neck and proximal urethera in a retropubic position in order to support the bladder neck and regain continence

31
Q

what is the surgical treatment for UI

A 
injection therapy 
retropubic suspension 
burch colposuspension (elevation of vaginal wall to lateral pelvic wall) 
urethral stapes and slings 
artificial urinary sphincter
32
Q

how do urethral tapes and slings work

A

lift up urethra and hold in place to prevent urethral movement

33
Q

what are the complications of urethral slings

A

– voiding dysfunction (retention or de novo bladder overactivity

  • vaginal, urethral and bladder perforation/erosion
  • pain
  • damage to bowel or blood vessels
34
Q

how does a artificial urinary sphincter work

A

provides a constant circumferential pressure to compress the urethra. To void, the pump is squeezed, which transfers fluid to the reservoir balloon, thereby deflating the cuff. The cuff then automatically re-fills within 3 minutes

used for mod/ severe SUI/ uretheral sphincter deficiency

good long term success

35
Q

what are the complications of an artificial uretheral sphincter

A

urethral atrophy, mechanical failure, urethral erosion, bladder overactivity or reduced compliance, infection

36
Q

what is bladder over activity

A 
detrusor overacitivity 
causes 
-urgency (+/- urge incontinence)
-frequency 
-nocturia
37
Q

what is the conservative treatment for an overactive bladder

A 
pelvic floor exercises 
biofeedback 
acupuncture
electrical stimulation 
behaviour modification: fluid intake, stimulants (caffeine, alcohol), bladder training
38
Q

what medication for an overactive bladdr

A

anticholinergics (antimuscarinics) which inhibit contractions
-oxybutynin, solifenacin, tolterodine…

beta adrenoreceptor agonists; β3 sub-typE induce detrusor relaxation. β3-AR agonists increase bladder capacity with no change in micturition pressure and the residual volume
-Mirabegron

39
Q

what causes bladder overacticity

A

acetylcholine acts on muscarinic receptors on the bladder smooth muscle to cause involuntary contractions and provoke symptoms of bladder overactivity

40
Q

what are the contraindications for anticholinergics for bladder overactivity

A

uncontrolled open angle glaucoma, myasthenia gravis, BOO, bowel disorders (UC, bowel obstruction)

41
Q

what are the side effects of anticholinergics

A

dry mouth, constipation, blurred vision, urinary retention, cognitive impairment

42
Q

what are the contraindications to beta agonists

A

uncontrolled hypertension

43
Q

what are the treatments for refractory cases of overactivity of the bladder

A

intravesical botulinum toxic (sparing the trione, temporarily paralyses detrusor)

neuromodulation (sacral nerve stimulation (S3) to inhibit detrusor activity)

clam ileocystoplasty (attaching segment of ileum to increase bladder volume)

ileal conduit urinary diversion with stoma (intractable cases only)

Renal (27 decks)

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