Urogynaecology Flashcards
What is urinary incontinence?
Involuntary leakage of urine. Most commonly it is stress incontinence, urge incontinence, or mixed, although there are other types.
Wht are the other types of incontinence? (other than stress, urge, and mixed)
Overflow Bladder fistulae Urethral diverticulum Congenital anomalies Functional Temporary
What is overflow incontinence?
Leakage of urine from an overful urinary bladder often in the absence of any urge to urinate.
What is bladder fistulae incontinence?
Urinary leakage cause by an opening between the bladder and another organ
What is urethral diverticulum incontinence?
Urinary leakage via an out-pocketing of the urethra into the anterior vaginal wall
What is functional incontinence?
Physical and mental barriers that prevent the patient reaching the toilet e.g. dementia, immobility
What is temporary incontinence?
Urinary leakage due to reversible factors such as constipation or UTI
Define stress incontinence.
Involuntary leakage of urine during increased intra-abdominal pressure in the absence of a detrusor contraction.
Who is stress incontinence typically seen in?
Women after childbirth due to denervation of pelvic floor.
Define urge incontinence?
Presence of urgency (and often frequency and noctuira) in the absence of UTI or any other obvious pathology.
What is the pathophysiology of urge incontinence?
Detrusor muscle overactivity
When is urge incontinence seen?
Often idiopathic, but seen with:
- MS
- Spina bifida
- Other neurological conditions
- Hx pelvic or incontinence surgery
A woman presents to her GP with small volumes of urine leaking when she coughs and sneezes, or lifts anything heavy.
What might we find on examination of this woman?
Prolapse of urethra and anterior vaginal wall.
What kind of trigger factors do some people with urge incontinence have?
Cold weather
Hearing running water
Sometimes sneezing or coughing can cause detrusor activity, giving a false impression of stress incontinence.
How much urine leaks in urge incontinence compared to stress incontinence?
Typically larger volumes in urge incontinence.
How should urinary incontinence be investigated initially?
Bladder diary for 3 days min.
Vaginal examination to exclude pelvic organ prolapse.
Urine dipstick and culture if UTI suspected.
What should be documented in a bladder diary?
Frequency and volume of incontinence.
Triggers.
Normal frequency and baldder capacity if stress incont.
When are urodynamic studies done?
With stress incontinence when surgery is considered - confirms diagnosis and rules out concomitant detrusor over-activity.
What does management of urinary incontinence depend on?
What type of incontinence it is.
How should urge incontinence be managed?
- Bladder retarining for 6 weeks +
- Bladder stabilising drugs (antimuscarinics first line)
Describe bladder retraining.
Gradually increasing the time between voiding i.e. not going when they feel the urge.
What antimuscarinics are recommended by NICE for urge incontinence?
- Oxybutynin IR (avoid in older women)
- Tolterodine IR
- Darifenacin OD
How should stress incontinence be managed?
- Lifestyle modification
- Pelvic floor muscle training (8 contractions TDS for 3 months at least)
- Treat risk factors such as chronic cough
- Surgical procedures
What lifestyle modification can help with stress incontinence?
Weight loss
Smoking cessation
What lifestyle modification can help with urge incontinence?
Fluid intake changes
Avoid caffeine and alcohol
What surgical procedures can be used to manage stress incontinence?
Tension free vaginal tape = most commonly performed
- Burch colposuspension
- Laparoscopic colposuspension
- Periurethral injection
- Transobturator mid-urethral sling
What medical management is licenced for stress incontinence?
Duloxetine for moderate and severe, if post surgery, or pt is not suitable for surgery.