Urinary Incontinence Flashcards

1
Q

How can you broadly categorise incontinence?

A

Neurogenic / Non-neurogenic

By presenting signs

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2
Q

What presenting signs can you use to categorise urinary incontinence?

A
Congenital - anatomical 
Overflow -leaking due to obstruction
- Paradoxical 
Stress -increases in abdo pressure e.g. cough 
Urge - UTI 
Response to treatment 
Hormonal - sphincter mechanism
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3
Q

What is paradoxical incontinence ?

A

Overflow incontinence due to obstruction

Often when patient lies down

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4
Q

What are the juvenile causes of incontinence?

A

OFTEN ANATOMICAL

Ectopic ureters 
USMI
Genitourinary dysplasia 
Bladder hypoplasia 
Intersex 
Patent urachus 
Neuro dz
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5
Q

What is USMI

A

Urethral sphincter mechanism incontinence

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6
Q

What is the most common cause of adult incontinence?

A

USMI

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7
Q

What are the causes of incontinence in adults ?

A
USMI
Prostatic dz
Neuro
Urogenital neoplasia 
Fistulae 
Bladder atony 
Cystitis 
Detruser instability 
Pelvic masses
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8
Q

What dogs are more likely to get USMI?

A

Neutered bitches

Castrated male and entire bitches also

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9
Q

What urine leakage is associated with USMI?

A

Leakage during recumbency as increased intra-abdominal pressure

May be progressive or manifests when another condition presents e.g. PUPD increases volume in bladder

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10
Q

What risk factors are associated with USMI?

A

Neutering esp in large breeds

Breed- Irish setter, Rottie, Old English Sheepdog

Large

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11
Q

How do you diagnose USMI?

A

History
PE - unremarkable

Rule out other causes with clin path. urine, biochem

and observe response to trial tx

Diagnostic imaging if no response

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12
Q

How can you treat USMI?

A

Treat UTI
Treat systemic dz
Diet if obese
Medicate to increase urethral tone - PPA, oestriol (f) testosterone (m)

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13
Q

What controls bladder relaxation?

A

Beta adrenergic fibres (sympathetic) from the hypogastric n

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14
Q

How is urethral tone maintained?

A

Alpha adrenergic fibres from the hypogastric n (Sympathetic)

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15
Q

How does the bladder contract?

A

Parasympathetic action of the pelvic n on the detruser muscle

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16
Q

Which nerve is responsible for sphincter tone?

A

Pudendal n (somatic)

17
Q

What is ureteral ectopia?

What is it more common in?

A

Ureters bypass bladder and open into urethra or vagina

Female dogs

18
Q

What clinical signs are associated with ureteral ectopia?

A

Continual dribbling urine
- severity dependent on where ureters empty
Still posture and urinate normally too
Scalding

May also have concomitant USMI, hydronephrosis/ureter

19
Q

What type of ureteral ectopia are dogs more likely to have?

A

INTRAMURAL

- goes in wall of bladder

20
Q

What type of ureteral ectopia are cats more likely to have?

A

EXTRAMURAL

Implants directly into urethra or vagina

21
Q

How can you treat ectopic ureters?

A

Manage UTI if present
Surgically reposition ureteral opening
- CONTINENCE ONLY IN HALF due to concurrent USMI/hypoplastic bladder

Concurrent medical therapy - PPA

22
Q

When is bladder atony seen?

Why does it occur?

How do you treat?

A

Secondary to bladder distension

Tight junctions in bladder wall disrupted.

Need in dwelling catheter