Urogenitary Flashcards
Urge incontinance
Overactive bladder (frequently go to toilet)
Voiding urine before reach toilet
Micturition (discharge of urine)
Process and control
Process
- activate parasympathetic
- inhibit sympathetic
Control
- brain stem facilities
- cerebral cortex inhibits
Peripheral nerves action
Parasympathetic: (cholinergic) bladder contraction
Sympathetic: bladder relaxation (beta)
Sympathetic: bladder neck and urethral contraction (alpha)
Somatic: pelvic floor contraction
Categories of incontinence
Urge Stress Overflow Functional Mixed
Causes of OAB (overactive bladder -> lead to urge incontinence)
Neuro and non-neuro
Non-neuro
- outlet obstruction
- idiopathic (unknown cause)
Neurological
-stroke
-parkinsons
Spinal cord injury
Causes of UIC
- inappropriate
Stress incontinence def
When small amount of urine escapes while coughs, sneezes, laughs, jumps, lifting heavy weights
Stress incontinence causes
Tap not as tight as normal
- <75yo women
- hypermotility of bladder neck and urethra
- intrinsic spincter problems
Associated with surgery, trauma, ageing, childbirth etc
Overflow incontinence def
Urine leaks from OVERFILLED bladder
Causes of overflow incontinence
- over distention of bladder
- bladder outlet obstruction/blockage
- non-contractile bladder
Functional incontinence
Does not invole lower urinary tract
Result of psychological , cognitive or physical impairment
Incontinence Diagnostic tests
Stress test Post-void residual - <50ml (adequate) - > 150ml (avoid bladder relaxing drug) Blood test ( Ca, glucose, Cr) Urine culture Cystometrics Bladder charts
UIC treatment
- meds to relax the bladder
Propan-theline
Imi-pra-mine
Oxybutynin
Tol-tero-dine
Soli-fena-cin
Dari-fena-cin
Mirabegron (UIC drug) MOA
Beta3 adrenergic receptor AGONIST
Activate b3 in the detrusor muscle of bladder
Relaxes the muscle and increases bladder capacity
AE of UIC drugs
Common : ⬆️BP, nasopharyngitis (鼻咽炎)
Infrequent : tachycardia
Non drug treatment for UIC
Fluid management
- aim1.5-2L
- reduce caffein and alcohol intake
Bladder retraining, pelvic floor muscle training
- kegal
- avoid holding just go incase
SIC (open sphincter)
- meds tighten the tap
Phenyl-propanol-amine
Estrogen
SIC treament
Mostly non-drug
Pads
Surgery
Overflow incontinence
Treating : closed sphincter
Anticholinergic not really useful - treat UIC
Functional incontinence treatment
Brain failure
Anticholinergic drug will be no good
