Urinary Incontinence and Prolapse Flashcards
What is stress UI?
on effort/ exertion
What is urgency UI?
immediately preceded by urgency
What is OAB?
urgency that occurs with or iwthout incontinence; usually with freq and nocturia
What is OAB dry?
OAB wtihout incontinence
What is the aetiology of urinary incontinence?
age; parity; obesity; pregnnacy; obsetric history; menopause; UTI; smoking; FHx
What are “storage” symptoms?
frequency; nocturia; urgency; UUI; SUI; constant leak
What does a constant leak of urine suggest?
fistula
What are voiding symptoms?
hesitancy; straining to void; poor flow
What do voiding symptoms suggest?
obstruction
What do postmicturition symptoms?
prolapse- urine sitting that is hard to get out
What are postmicturition symptoms?
incontinence; incomplete emptying
What should be done for an examination with urinary incontinence?
BMI; abdo exam; vaginal exam; PR; cognitive impairment
What causes OAB and UUI?
detrusor muscle contracts frequently and involuntarily
What causes SUI?
urethral hypermobility; urethral sphincter weakness
What causes urethral sphincter weakness in women?
trauma; hypoestrogenism; aging; surgical procedures
What is urethral hypermobility?
excessive displacement of the urethra and bldder neck during exertion and increased abdo pressure
What are hte investigations for UI?
UA; post void resiudal USS; urodynamics; cystoscopy
What are the lifestyle interventions with UI?
caffeine; fluid intake; weight loss
What is the conservative managemnt of urge urinary incontinence?
pelvic floor physio; bladder retraining; lifestyle
What antimuscarinics are used in urge UI?
oxybutynin; tolterodine; darfenicin
What is the mechanism of antimuscarinics in urge UI?
reduce intra-vesicla pressure; increase compicance; reduce uninhibited contractions
What are the SE of antimuscarinics?
dry mouth; constipation; blurred vision; somnolence
What is the second line drug for urge urinary incontinence?
mirabegron
What is the action of mirabegron?
selective B3 ADR agonist- relaxes bladder smooht muscle
When might desmopressin be added in with OAB?
nocturia
What must patients be able to do to have botulinum toxin injections?
intermittent self catheterisation
What is the medication for SUI?
duloxetine
What type of drug is duloxetine?
combined noradrenaline and serotonin reuptake inhibitor
What is the effect of duloxetine?
increased intraurethral closure pressure
What surgery is available for SUI?
tension free tape; colposuspension; intramural bulking agents; artifical sphincters
What is complete vaginal eversion known as?
uterine procidentia
What are the causes of prolapse?
age; parity; pregnancy; oestrogen defiencey; obesity; neuro condition; genetic connective tissue disorder
What is POP-Q?
whilst striaing 6 sites and 3 sites at rest are measured in relation t othe hymenal ring to look at degree of prolapse
What is a stage 1 prolapse?
1cm above hymen
What is a stage 2 prolapse?
1cm around hymen
What is a stage 3 prolapse?
> 1cm beyond hymen
What is stage 4 prolapse?
complete vaginal eversion
What are the complications with pessaries?
discharge; ulcerations (fistula); fibrous bands
How often should a pessary be changed?
6 monthly
What is the surgical option for anterior and posterior prolapse?
vaginal repair
What are vaginal surgical options for apical prolapse?
sacrospinous fixation and colpocliesis
What is sacrospinous fixation?
cervix/ vagina attached to sacrospinous ligament
What is colpocleisis?
close up vagina
What should be done with colpocleisis if woman still has uterus?
2 channels left on either side to see PMB
What is a pectopexy?
subtotal hysterectomy; cervix bilaterally attached to iliopectineal ligament
What is a sacrohysteropexy/sacrocolpopexy?
attaching uterus/vagina to anterior longitudinal ligamentwith mesh and coverd with peritoneum
