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Repro > Urinary Incontinence > Flashcards

Urinary Incontinence Flashcards

1
Q

What are the characteristics of the UUT

A
  • Kidney & ureters
  • A low-pressure distensible conduit with intrinsic peristalsis
  • Transport urine from nephrons via ureters to the bladder
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2
Q

Characteristics of the LUT

A
  • Bladder and urethra
  • Low-pressure storage
  • Efficient expulsion of urine at appropriate place & time
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3
Q

What is the vesico-ureteric mechanism

A
  • Protects the nephrons from any damage secondary to retrograde transmission of back pressure or infection from the bladder
  • Vesico-ureteric valve only allows flow 1 way
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4
Q

What is the length of the urethra (male and female)

A
  • Women - 4cm
  • Men - 25cm
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5
Q

What is the nerve supply of the bladder

A
  • Storage - hypogastric nerve - T10-L2 (sympathetic) (s for storage)
  • Voiding - pelvic nerve - S2-4 (parasympathetic)
  • Voluntary - pudendal nerve - S2-4 (somatic)
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6
Q

Why are women more prone to bladder leakage

A
  • The prostate aids voluntary control in men
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7
Q

What are the characteristics of bladder filling

A
  • Accomodate increasing volume at constantly low pressure
  • Inhibition of contractions by giving rise to gradual awareness of filling
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8
Q

What is the cortical activity of bladder filling

A
  • Activating reciprocal guarding reflex by Rhabdosphincter contraction
  • Increase sphincter contraction & resistance
    • Activates sympathetic pathway
    • Reciprocal inhibition of the parasympathetic pathway
    • Mediates contraction of bladder base and proximal urethra
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9
Q

What is normal bladder capacity

A
  • 400-600ml (1 pint)
    • 125ml (1/4 pint) first sensation
    • 250ml (1/2 pint) start to feel the need but not desperate
    • 500ml (1 pint) need to go - max systemic capacity
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10
Q

How does bladder emptying occur

A
  • Detrusor contraction
  • Urethral relaxation
  • Sphincter co-ordination
  • Absence of obstruction or anatomical shunts (cystocele, diverticulum)
  • Cortical influence (pontine micturatioon centre) –> activation of parasympathetic oathway & inhibition of sympathetic pathway
    • E.g. convienient location
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11
Q

What is urinary incontinence

A
  • Any involuntary leakage of urine
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12
Q

What is stress urinary incontinence

A
  • Involuntary leakage on effort or exertion, on sneezing or coughing
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13
Q

What is urge incontinence

A
  • Involuntary leakage accompanied by or immediately preceded by urgency
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14
Q

What is mixed urinary incontinence

A
  • Involuntary leakage accompanied by or immediately preceded by urgency & on effort pr exertion, or on sneezing or coughing
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15
Q

What is the epidemiology of urinary incontinence

A
  • 10-25% of women age 15-60
  • 15-40% women >60
  • >50% women in nursing homes
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16
Q

What is the impact of urinary incontinence

A
  • Impairs QoL
  • Reduces social relationships and activities
  • Impairs emotional and psychological well-being
  • Impairs sexual relationships
  • Embarrassment and diminished self-esteem
  • Average length of suffering - 5 years
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17
Q

Risk factors of urinary incontinence

A
  • Age
  • Parity - pregnancy main risk factor
  • Menopause
  • Smoking
  • Medical problems
  • Increased intraabdominal pressure
  • Pelvic floor trauma
  • Denervation
  • Connective tissue disease
  • Surgery
  • Instrumental delivery
18
Q

Theory of female urinary incontinence

A
  • Both stress and urge incontinence arise from the same anatomical defect in the anterior vaginal wall and pubo-urethral ligament (PUL)
    • Urethral/bladder neck closure dysfunction and USK
  • Suburethral hammock laxity might result in stimulation of bladder neck stretch receptors, provoking a premature micturation rllfex and urgency incontinence
19
Q

How are patients with urinary incontinence assessed

A
  • History
  • Examination
  • Investigations
  • Management
20
Q

What is important in the history of UI

A
  • Age, parity, mode of deliveries, weight of heaviest baby, smoking, HRT
  • Medical problems
    • DM (causes polyuria), anti-HTN medications dioxide relaxes urethra, reduce furosemide) glaucoma (cannot have urgency medication), heart/kidney/liver problems, cognitive problems antidepressants/anti-psychotics (anti-cholinergics)
  • Previous PFMT, surgical treatment of SUI or POP
21
Q

What is normal frequency

A
  • Urge is normal, urgency is not
  • Daytime frequency - 7
  • Nocturia - 1
  • Number increase by 1 each decade after 60
22
Q

What irritation symptoms for patients complain of

A
  • Urgency; sudden compelling desire to void that is difficult to defer
  • Increased daytime frequency (>7)
  • Nocturia (>1)
  • Dysuria
  • Haematuria
23
Q

What incontinence symptoms do patients complain of

A
  • Stress UI
  • Urhency UI
  • Coital incontinence
  • Severity - pads/day
24
Q

What voiding symptoms do patients complain of

A
  • Straining to void
  • Interrupted flow
  • Recurrent UTI
25
Q

What other symptoms need to be asked about in the history of UI

A
  • Fluid intake: quantity and quality
  • Effect on QoL - scale 1-10
  • Prolapse symptoms
    • Vaginal lump/dragging sensation in vagina
  • Bowel symptoms
    • Anal incontinence, constipation, faecal evacuation dysfunction, IBS
26
Q

What should be done before the clinic of UI

A
  • £ day urinary diary
    • Fluid intake: quantity and quality
    • Urine out-put (exclude nocturnal polyuria)
    • Day-time frequency
    • Nocturia
    • Average voided volume
    • Can show if SUI or UUI
  • Urine dipstick
27
Q

What examination should be done in UI

A
  • General
  • Abdominal Neurological
  • Gynaecological
  • Pelvic floor assessment (Oxford scale)
28
Q

What should be looked at those with UI and bladder/pelvic floor problems

A
  • Prolapse
  • Stress incontinence
  • Uro-genital atrophy changes
  • Pelvic mass (space-occupying lesion)
  • Pelvic floor tone, strength, awareness
29
Q

What investigations in UI

A
  • Urinalysis
    • Multistix +/- MSSU
    • Post voiding residual volume assessment
      • Usually bladder scanning
      • Only symptoms of voiding difficulties
    • Urodynamic - only indicated if surgical treatment contemplated
      • Uroflowmetry
      • Multi-channel cytometry
30
Q

What is the general management of UI

A
  • Lifestyle changes - e.g. reduce intake, lose weight (>30), reduce caffeine, avoid chocolate, avoid fizzy drinks, avoid sugar/sweeteners
  • Medica treatments
  • Physio
  • Surgery
31
Q

What is the management of stress urinary incontinence

A
  • Urethral closure pressure increased by
    • Pelvic floor muscle training
    • Surgery
    • Pharmacological agents
32
Q

Lifestyle changes for treatment of UI

A
  • Stop smoking
  • Lose weight
  • Eat more healthily to avoid constipation
  • Stop drinking alcohol and caffeine
33
Q

What is the conservative treatment of UI

A
  • Should be used on everyone (unless previously failed)
  • Pelvic floor muscle training
    • Reinforcement of cortical awareness of muscle groups
    • Hypertrophy of existing muscle fibres
    • General increase in muscle tone and strength
34
Q

Pharmacological treatment of UI

A
  • Yentreve (duloxetine)
    • Moderate to severe stress UI
    • Adjuvant to exercises
    • Can cause nausea
35
Q

Surgical management of UI

A
  • Colosuspension
    • Lifting the urethra back up
  • Mid-urethral slings retro-pubic TVT
    • Tension-free vaginal tape (TVT) was introduced as minimally invasive procedure to reinforce structures
    • 80% cure at 11-years follow up
    • Problem with foreign body
36
Q

What is overactive bladder syndrome

A
  • Symptoms complex usually related to urodynamically demonstrable detrusor overactivity
  • Symptoms syndrome - not easy to diagnose
37
Q

Symptoms of overactive bladder syndrome

A
  • Urgency (with/without incontinence)
    • Usually with frequency and nocturia
38
Q

What are the risk factors for overactive bladder syndrome

A
  • Advanced age
  • Diabetes
  • UTIs
  • Smoking
39
Q

Treatment of overactive bladder syndrome

A
  • Treat symptoms
  • No immediate cure
  • MD approach
  • Lifestyle
  • Bladder training
  • Pharmacological
40
Q

Lifestyle changes as management of overactive bladder syndrome

A
  • Normalise fluid intake
  • Reduce caffeine, fizzy drinks, chocolate
  • Stop smoking
  • Weight loss
41
Q

What is the bladder training programme in overactive bladder syndrome management

A
  • Timed voiding with gradually increasing intervals - continence nurse
42
Q

Pharmacological treatments of overactive bladder syndrome

A
  • Antimuscarinic
    • Oral
      • Solifenacin
      • Fesoteridine
      • Trospium chloride
      • Darifenacin
      • Lyrical XL
      • Oxybutynin
    • Transdermal
      • Kentera patches
  • Tricyclics
  • Botox
  • Neuromodulation

Repro (16 decks)

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