Urinary Incontinence and Prolapse Flashcards
At what point does the bladder signal for voiding?
400ml full
What is the micturition reflex?
This is parasympathetics that supply the bladder sending signals to the spinal bladder center (S2,3). There are descending controls from the brain to prevent overactive detrusor muscle. When bladder reaches the right volume and distension then there is signal to void
What is meant by overflow incontinence?
This is incontinence due to obstruction of the bladder inhibiting micturition. There will be a large and palpable bladder with discomfort. Patients may also present with being wet at night
How is overflow incontinence treated?
Need to confirm by examination (will be uncomfortable, can’t get below it, dull percussion) then locate the obstruction. Catheterise to relieve the pressure and fix the obstruction
What is urge incontinence?
This is an increase in frequency but a decrease if urinary voiding volume due to an overactive detrusor muscle.
What can cause an overactive detrusor?
irritation within the bladder
lack of descending controls from the brain
What is used to diagnose urge incontinece?
Urodynamics - will have multiple spikes
What is used to treat urge incontinence?
Dietary adjustment, bladder retraining, antimuscurinics (oxybutynin) or beta-3-adrenergics, can use botox injections or surgery
What is stress incontinence?
This is incontinence due to increased abdominal pressure without the presence of detrusor contraction. It is mainly caused by childbirth causing damage to the perineum and urethra
usually brought on by coughing/laughing
How is stress incontinence diagnosed?
Urodynamics (to exclude urge)
How is stress incontinence treated?
diet, pelvic floor exercised, (duloxetine) and surgery (can do minimally invasive taping procedure)
What are some UI symptoms?
frequency, urge, nocturia, stress, OAB
voiding: hestitancy, incomplete, difficulty, spraying
What examinations should be done for UI?
BMI, abdo (masses, bladder), vaginal (prolapse), PR (masses), cognitive impairment assessment
What investigations should be carried out for UI?
urinalysis, post void residual, urodynamics, cystoscopy, imaging
Oxybutynin and tolteride are examples of…
anti-muscurinics
Explain anti-muscurinic action in UI
will block the cholinergic action of the parasympathetics to reduce the tone and voiding frequency
examples include oxybutynin and tolteride
Mirabegron is an example of…
beta-3-agonist
beta-3-agonists are…
potentiators of sympathetic supply to the detrusor - causes relaxation
What can be used in the treatment of OAB (pharma)
oxybutynin, tolteride or mirabegron
What is significant about the use of antimuscurinics?
50% of patients will stop within 3 months due to side effects and lack of effect
What are some side effects of AMs?
dry mouth, constipation, visual blurring and solomnence
What is a cystocele?
This is involving the ANTERIOR compartment. it is the prolapse of the bladder into the vagina
What is a vaginal vault prolapse?
AKA an enterocele. This involves the Middle/APICAL compartments and is the prolapse of the vagina due to compression from the bowel.
What is a retrocele?
This involves the POSTERIOR compartment. It is the prolapse of the rectum into the vagina
How is POP diagnosed?
It is mainly a clinical diagnosis based off symptoms and examination but there can be difficulty in the determining the origin. Can use USS and MRI to differentiate
How are POP recorded?
POP-quantification score (positive numbers if below the hymen)
How are POPs staged?
1 = >1cm above hymen 2 = -1-1 cm in relation to hymen 3 = >1cm beyond hyem 4 = full vaginal emersion
What is the management of posterior and anterior prolapse?
Vaginal repair
What is the management of an apical prolapse?
Pessaries or surgery
Give some symptoms of prolapse?
bulging, pressure, pain on intercourse, difficulty inserting tampon
If posterior prolapse what symptoms would occur?
difficulty with defecation and incomplete
If anterior prolapse then what symptoms would occur?
difficulty voiding and incomplete
