Urogynaecology Flashcards
state the 4 stages of the micturition cycle
1- bladder fills
2-first sensation to void
3-normal desire to void
4-micturition
what happens at stage one (bladder fills) of the micturition cycle 3
detrusor mucle relaxes
urethral sphincter contracts
pelvic floor contracts
what happens at stage two (first sensation to void) of the micturition cycle 3
bladder half full
-urinarition voluntarily
-inhibited until appropriate time
what happens at stage three (normal desire to void) of the micturition cycle
nothing- just says normal desire to void
what happens at stage four (micturition) of the micturition cycle 2
detrusor muscle contracts
pelvic floor relaxes
what nerves are involved in mictrution 2
pelvic nerve
pudendal nerve
what are some types of urinary incontience in women 3
overactive bladder
mixed incontinence stress + urgency
stress incontience- bladder outlet closure defect
what types of bladder outlet closure defects are there 2
anatomical defect in urethral support
sphincter muscle weakness
define urinary intontience
involuntary loss of urine which is objectively demonastre and which is a social or hygienic problem
define overactive bladder
syx of urgency with or without urgen incontinence
-usually with frequency & nocturia
DUE TO DETRUSOR OVERACTIVITY
define urge inctonience
leakage of urine in response to an involuntary contraction of the detrusor muscle
define stress urinary incontience (SUI)
leakage occurs with rise in intra-abdominal pressure WITHOUT a detrusor contraction (coughing, laughing, running, walking)
-signs or symptoms of urinary leakage with increased intra-abdominal pressure
define urodynamic stress incontience (USI)
urodynamic proven leakage of urine with increased intra-abdominal pressure
define mixed incontience
co-exisiting SUI (stress urinary inctontience) and OAB (overactive bladder)
causes of overactive bladder 9
neurologcial -parkions, stroke, MS, cognitive function
constipation
previous surgery
acute UTI
caffiene
alcohol
bladder abnormlaites- tumour, stones
high urine production
-medication, excess fluid intake, diabetes, poor kidney function
basic pathophys of stress urinary intoneitnece
loss of suburtheal suppot -> increased urethral mobiltiy -> movement of proximal urethral sphincter out of abdominal space-> therefore increased intraabodminal pressure not spread evenly throughout bladder
what is a major consideration with urinary incontinence
the impact on quality of life
main symptoms of urinary incontience 10
stress incontience
requency
urgency
urge incontinence
nocturia
enuresis
haematuria
dysuria
voiding porvelsm
pain
prolapse syx
risk factors of urinary incontinece 10
mobility
mental agility
renal system
cardiac system
chest problems
drug therapies
previous pelvic surgery
obstertic hsiotry
menopausal status
examinations for urianry incotinence 2
abdominal/bimanual examination
vaginal examination
what to check for in abdominal/bimanual exmainaiton in urinary incontinence 3
pelvic masses
palbable bladder
imporession of pelvic floor tone
what to check for in vaginal examination in urinary incontinence
bivalve speculum
check walls in turn for:
-prolapse, atorphy, fistulae, ulceration
investigations for urinary incontience 4
urinary dip ± culture EVERY WOMEN
-leucocytes & nitries- UTI
-haematuria- further investigation
-glucose- ?diabetes
bladder diary
-minimun 3 days
-input/ output/ times of leaking
cystoscopy & renal tract imaging
-haematuria
-recurrent UTIs
Urodynamic testing
-expensive and time consuming
define urodynamic testing
dynamic study of bladdr funciton
-uroflowmetry (measuirng flow)
0filling and voiding cystinetry (measuring pressures in bladder and abdomen and calculating detrusor pressure
