Urinary Incontinence and Prolapse Flashcards
What is stress incontinence?
Involuntary urine leakage on effort/exertion
What is urge incontinence?
Involuntary urine leakage accompanied/immediately preceded by urgency to urinate
What is mixed incontinence?
Involuntary urine leakage associated with both urgency and exertion
What is overactive bladder?
Urgency with/without incontinence and is usually accompanied by nocturia and frequency
Give some potential risk factors for incontinence
Age Parity Obesity Pregnancy Menopause UTI
What is clinical evaluation of a patient with incontinence focused on?
Storage symptoms (frequency/nocturia/urgency/incontinence) Incontinence Voiding symptoms Postmicturition symptoms Prolapse Diet Medication – particularly psychoactive medications Sex Obstetric history
What examinations should be carried out on a patient with incontinence?
Abdominal exam
Vaginal exam
PR exam
Give some investigations that may be used for stress incontinence
Urinalysis
Urodynamics
Cystoscopy
Imaging
Give some conservative management that may be used for incontinence
Lifestyle interventions (reduce caffeine/fluid/weight)
Pelvic floor exercises
Bladder retraining
What medication may be used to treat urge incontinence?
Antimuscarinic agents (oxybutynin/tolterodine) Beta-3 adrenoceptor agonists (mirebegron)
What is the effect of antimuscarinic agents on the bladder?
Reduce intra-vesical pressure
Give some common side effects of antimuscarinics
Dry mouth
Constipation
Blurred vision
Somnolence
What is the effect of beta-3 adrenoceptor agonists?
Relaxes bladder smooth muscle by activating beta-3 adrenoceptor
What other ways may be used to manage an overactive bladder?
Desmopressin Topical oestrogen Botox Percutaneous sacral nerve stimulator Augmentation cystoplasty
How can stress incontinence be managed?
Weight loss Physiotherapy Incontinence therapy Surgery Duloxetine
What are the three compartments of prolapse?
Anterior (uterus)
Middle/apical
Posterior (bowel)
Give some symptoms associated with a cystocele (anterior)
Bulge
Pressure
Incomplete bladder emptying
Incontinence
Give some symptoms associated with uterine prolapse
Dragging Back pain Mass present Difficulty inserting/retaining tampon Dyspareunia
Give some symptoms associated with rectocele (posterior)
Bulging
Pressure
Difficulty defaecating
What investigations may be used in prolapse?
USS (masses present)
MRI (complex surgery)
What conservative management may be done for prolapse?
Weight loss
Pelvic floor exercises
Vaginal pessaries
Young women can manage their own pessaries. True/false?
True
What surgery may be done for prolapse?
Sacrospinous fixation
Colpoclesis
Sacrohysteropexy
What is involved in sacrohysteropexy?
Resuspension of the prolapsed uterus to lift the uterus and hold it in place
