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Urinary System > Urinary Incontinence > Flashcards

Urinary Incontinence Flashcards

1
Q

Look at Bladder Control note

A

Go through the Note you lazy shit

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3
Q

State 3 ways a lower motor neurone lesion such as Cauda Equina may present (S2, S3, S4 affected)

A
  • Large amount of residual urine +/- overflow incontinence (Due to low Detrusor pressure)
  • Reduced perianal sensation
  • Lax anal tone
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4
Q

State 2 ways an upper motor neurone lesion may present

A

Detrusor Sphincter Dyssynergia

  • High pressure Detrusor contractions
  • Poor sphincter coordination
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5
Q

What are 3 classes of LUTS (Lower Urinary Tract Symptoms)

A

Storage;
- Increased frequency/ Urgency/ Nocturia/ Incontinence

Voiding;
- Slow stream/ Intermittent/ Straining/ Terminal dribble

Post-Micturition;
- Feeling of incomplete emptying/ Post micturition dribble

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6
Q

Urinary Incontinence is the “Complaint of any involuntary leakage of urine”

List 4 types of Incontinence

A
  1. Overflow Incontinence
  2. Stress Urinary Incontinence (SUI);
    - Complaint of involuntary leakage on effort/ exertion/ sneezing/ coughing
  3. (Urgent) UUI;
    - Complaint of involuntary leakage of urine accompanied by/ immediately preceded by urgency
  4. (Mixed) MUI;
    - Complaint of involuntary leakage of urine associated with urgency an also with exertion/ effort/ sneezing/ coughing
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7
Q

Overactive Bladder is more prevalent than Urgent UI.

What are 3 signs of OAB?

A
  • Urgency
  • Increased frequency
  • Nocturia

(Storage classification of LUTS)

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8
Q

List 4 aspects of Examination of Urinary Incontinence

A
  • BMI
  • Abdominal exam to exclude palpable bladder
  • Digital Rectum Examination (DRE) (Prostate in males)

Females;

  • Vaginal exam
  • Stress test
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9
Q

List some Investigations for Urinary Incontinence

A

Mandatory;
- Urine dipstick (UTI, Haematuria, Proteinuria, Glycosuria)

Basic non-invasive Urodynamics;

  • Post micturition residual volume
  • Frequency Volume chart

Optional;

  • Invasive Urodynamics
  • Pad tests
  • Cytoscopy
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10
Q

In Pressure-Flow studies, how do you calculate Detrusor pressure

A

Total bladder pressure- Abdominal pressure

Total bladder pressure- Probe in bladder
(Ab pressure- Probe in Anal canal)

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11
Q

List 6 general lifestyle management interventions for Urinary Incontinence

A
  • Moderate fluid intake
  • Don’t smoke
  • Weight loss
  • Decrease caffeine intake (UUI)
  • Avoid constipation
  • Fixed schedule for voiding
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12
Q

Give 3 examples of Contained Incontinence

A
  • Incontinence Pads
  • Sheath device (Condom catheter)
  • Indwelling Catheter (Urethral or Suprapubic)
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13
Q

Describe Specific management of SUI (Stress Urinary Incontinence)

A

Initial;
- Pelvic Floor Muscle Training (PFMT)

Pharmacological;

  • Duloxetine (Increases activity in EUS)
  • May be offered as alternative to surgery

Surgical;

  • Females: Permanent/ Temporary intention
  • Males: Artificial Urinary Sphincters, Male Sling procedure
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14
Q

Give 3 examples of Permanent Intention being used to surgically treat SUI in females

A
  • Retropubic suspension procedures
  • Classical fascial sling procedures
  • Low tension vaginal tapes (up to 10% have pain, vaginal problems)
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15
Q

Give 1 example of Temporary Intention being used to surgically treat SUI in females

A

Intramural bulking agents

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16
Q

Describe Specific management of UUI (Urgent Urinary Incontinence)

A

Initial;
- Bladder training (voiding schedule)

Pharmacological;

  • Anticholinergics (side effects due to M receptors at other sites)
  • B3 Agonists (Increased urine storage capacity)
  • Intravesical injection of Botulinum toxin (Inhibits ACh release)

Surgery;

  • Sacral nerve neuromodulation
  • Urinary diversion
  • Autoaugmentation
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17
Q

Define Bedwetting (Nocturnal Enuresis)

A

Involuntary wetting during sleep at least 2x/week in children >5, with no CNS defects

18
Q

What are 5 questions to ask in someone who comes in with Bedwetting?

A
  • Age?
  • Primary OR secondary? (Never sustained continence at night OR restarted having been dry for 6 months)
  • Daytime symptoms?
  • Dysuria? Oliguria?
  • Constipated?
19
Q

How do you manage Bedwetting?

A

Primary without daytime symptoms;
- Reassurance, positive reward system, Desmopressin

Primary with daytime symptoms;

  • Usually due to LUT disorders so Secondary care

Secondary;
- Treat underlying cause (UTIs, Constipation, Diabetes, Psychological problems etc)

20
Q

Describe the innervation to the Detrusor muscle and External Urethral Sphincter

A

Detrusor: Parasympathetic (S2, S3, S4)

EUS: Somatic (Pudendal, S2, S3, S4)

Urinary System (25 decks)

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