Urogynaecology assessment of pelvic floor disorders Flashcards
Define Incontinence and OAB
Incontinence: Involuntary leakage of urine
OAB: Involuntary detrusor contractions –> Urgency
What are the main symptoms of OAB?
1) Urgency
2) Frequency
3) Nocturia
4) “key in door” urgency
Define stress incontinence
Anything that leads to increased I-A pressure w/ weak urethral sphincter e.g. coughing, laughing,
What is the functional bladder capacity?
400ml
What is the epithelium and innervation of the detrusor muscle?
Ep: Smooth muscle w/ transitional epithelium
In: Sacral parasympathetic
What investigations would you do in an incontinent patient?
1) Urinalysis
2) ePAQ
3) Bladder diary (frequency vol. chart)
4) Residual urine measurement e.g. catheter/USS
What is ePAQ?
Questionnaire about urinary, bowel, vaginal and sexual symptoms
What information does a bladder diary present?
1) Diurnal variation
2) Fluid intake
3) Quantity of urine
4) Frequency
What are the non-pharmacological treatments for OAB?
1) Pads
2) Bladder drill training
3) LS changes e.g. W. Loss, stop smoking, reduce caffeine, avoid straining
What are the non-pharmacological treatments for stress incontinence?
1) Physiotherapy e.g. Pelvic Floor/Kegel
2) LS changes e.g. weight loss, stop smoking, reduce caffeine, avoid straining
How do pelvic floor exercises help treat SI?
PF Musc cont -> Urethra compression -> ^ urethral compression -> reduced leakage
What drugs can treat OAB?
1) Botulinum Toxin
2) Mirabegron
3) Oxybutynin
What surgical options for SI?
1) Sling
2) Suspension: Restores pressure to urethra and restores urethra
How do Mirabegron and Botox work in treating OAB?
Botox: Blocks Ach release, so V detrusor contraction
Mirabegron: Beta 3 agonist, relaxes detrusor and increases bladder capacity
How does Oxybutynin work and what are the side effects?
Anticholinergic as M2/3 agonist, V detrusor innervation and activity
SE: Blurred vision, constipation, dry mouth and cognitive impairment
