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Renal > Urinary Incontinence > Flashcards

Urinary Incontinence Flashcards

1
Q

What is urinary incontinence?

A

Complaint of any involuntary leakage of urine = common, distressing, embarrassing, socially stigmatising, often hidden

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2
Q

How common is urinary incontinence?

A

1 in 3 women

1 in 10 men

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3
Q

What are the types of urethral incontinence?

A

Urge incontinence, stress incontinence, mixed incontinence, overflow incontinence

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4
Q

How may urine leak by the extra-urethral route?

A

Ectopic ureter, vesico-vaginal fistula

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5
Q

What are the two phases of the micturition cycle?

A

Filling (storage) and voiding phases

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6
Q

What is compliance?

A

Ability of bladder to keep its pressure unchanged irrespective of bladder volume and afferent stimulation

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7
Q

What pressures contribute to the storage phase?

A

Intravesical, atmospheric, abdominal, urethral

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8
Q

What occurs in the voiding phase?

A

Detrusor pressure increases due to muscle contraction, urethral pressure is less than intravesical pressure so flow can occur, outflow mechanism relaxes

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9
Q

What gives the tracing in urodynamics?

A

Cystomethogram = catheter in the bladder and rectum (to give abdominal pressure)

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10
Q

What is the volume of a full bladder?

A

400ml

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11
Q

What are patients asked to do during a cystomethogram tracing?

A

Cough three times

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12
Q

How is the detrusor pressure calculated?

A

Abdominal pressure - intravesical pressure

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13
Q

What are the anatomical components of the micturition reflex?

A

Bladder and sphincters, spinal bladder centre, brain, S2-3

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14
Q

What nerves are involved in the micturition reflex arc?

A

Pelvic parasympathetic nerves, pudendal nerve

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15
Q

What controls the micturition reflex arc?

A

Descending control from the brain inhibits or enables the arc

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16
Q

What are some symptoms of outflow obstruction?

A

Bladder outflow is obstructed = huge palpable bladder, chronic retention, insensible incontinence, wet at night, renal impairment

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17
Q

What is urge incontinence a part of?

A

The urge syndrome

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18
Q

What are some features of urge incontinence?

A

Daytime frequency, small voided volumes, urgency provoked, enuresis (wet at night)

19
Q

What are some triggers for urge incontinence?

A

Key in door, sound of running water, standing up, coughing, laughing

20
Q

How are urge incontinence, urodynamic stress incontinence and detrusor overactivity diagnosed?

A

By urodynamics

21
Q

What can detrusor overactivity cause?

A

Urge incontinence = mostly middle aged women, most common cause

22
Q

What is detrusor overactivity?

A

Bladder dysfunction characterised by detrusor contractions occurring during inhibition of voiding

23
Q

What are some causes of urge incontinence?

A

Cystitis, tumour, excess central facilitation (stress), loss of central inhibition (paraplegia), destruction of S2-3 centre, pelvic surgery/fracture (parasympathetic nerve damage)

24
Q

What happens in urodynamic stress incontinence?

A

Urine leaks during increased intra-abdominal pressure = no detrusor contraction

25
Q

What causes urodynamic stress incontinence?

A

Due to damage to pelvic floor or urethral function = childbirth, smoking, obesity, diabetes, chronic cough

26
Q

When do people with urodynamic stress incontinence go to the toilet?

A

Early in the micturition cycle = frequent urination

27
Q

What are some features of an overactive bladder?

A

Often mixed picture = SUI often overlaps

Split into wet (37%) and dry (63%)

28
Q

What are some features of the examination?

A

Painless palpable mass arising from the pelvis = can’t get below it, dull to percuss

29
Q

How is overflow incontinence treated?

A

Assess renal function and treat obstruction
Catheterise and bladder rehab
Teach intermittent self catheterisation

30
Q

How is urge incontinence treated?

A

Avoid caffeine, biofeedback, bladder retraining, time bladder emptying, botox injection (unlicensed)
Neuromodulation (bladder pacemaker)

31
Q

What are some medical interventions for urge incontinence?

A

Enterocystoplasty
Anti-muscarinics = oxybutynin, tolterodine
Beta 3 adrenergics = mirabegron

32
Q

How is stress incontinence treated?

A

Weight loss and smoking cessation, pelvic floor physio
Medication (not much role) = duloxetine (5HT and NE uptake inhibitor)
Colpususpension open surgery largely replaced with minimally invasive tape procedures

33
Q

How is mixed incontinence managed?

A

Combination of urge and stress therapies = must ask which is more dominant

34
Q

What are some features of an ectopic ureter?

A

Rare = congenital, ureter joins on wrong side of sphincter mechanism, patient wet all the time

35
Q

What are some features of a vesico-vaginal fistula?

A

Urine falls out of hole = constant wetness

Caused by prolonged labour in developing world and pelvic surgery in developed world

36
Q

What is stress incontinence defined as?

A

Involuntary leakage on effort or exertion, or sneezing/coughing

37
Q

What is urge incontinence defined as?

A

Involuntary leakage accompanied by or immediately preceded by urgency

38
Q

What is urgency?

A

Complaint of sudden compelling desire to pass urine which is difficult to defer

39
Q

What is overactive bladder/urge syndrome?

A

Urgency, with or without urge incontinence, usually with frequency and nocturia

40
Q

What is detrusor overactivity incontinence defined as?

A

Incontinence due to an involuntary detrusor contraction

41
Q

What is mixed urinary incontinence defined as?

A

Involuntary leakage associated with urgency as well as effort/sneezing/coughing

42
Q

What are voiding symptoms?

A

Experienced during voiding phase = slow stream, spraying of stream, hesitancy, straining

43
Q

What is a frequency volume chart (FVC)?

A

Records volumes voided as well as the time of each micturition = day and night for at least 24hrs

44
Q

How long is a bladder diary recorded for?

A

3 days

Renal (36 decks)

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