Urological diseases Flashcards
Describe stress urinary incontinence
- leakage on effort or exertion, sneezing or coughing
- occurs as a result of bladder neck / urethral hypermobility and or neuromuscular defects causing intrinsic sphincter deficiency
- urine leaks whenever urethral resistance is exceeded by increased abdominal pressure
Describe urge urinary incontinence
- leakage accompanied by or immediately preceded by urgency
- may be due to bladder overactivity (detrusor instability) or less commonly due to pathology that irritates the bladder (infection, tumour, stone)
What is mixed urinary incontinence?
A combination of urge urinary incontinence and stress urinary incontinence
Bedwetting in elderly men usually indicates what?
High pressure chronic retention
Post micturition dribble can be due to what?
Bulbar urethra
A constant leak of urine suggests what?
- a fistulous communication between the bladder (usually) and vagina (e.g. due to surgical injury at the time of hysterectomy or caesarian section)
- or rarely due to the presence of an ectopic ureter draining into the vagina
Name risk factors for incontinence
- female
- caucasian
- genetic predisposition
- neurological disorders; spinal cord injury, stroke, MS, parkinsons
- anatomical, vesicovaginal fistula, ectopic ureter, urethral diverticulum, urethral fistula, bladder extrophy, epispadias
- childbirth; vaginal delivery, increasing parity, pregnancy
- pelvic, perineal and prostate surgery
- radical pelvic radiotherapy
- diabetes
Name promoting factors for incontinence
- smoking; causing cough
- obesity
- infection; UTI
- increased fluid intake
- poor nutrition
- ageing
- cognitive deficit
- poor mobility
- oestrogen deficiency
Name red flags of an incontinence history
- pain
- haematuria
- recurrent UTI
- significant voiding / obstruction symptoms
- history of pelvic surgery / radiotherapy
Name the basic investigations for incontinence
- bladder diary (frequency/ volume chart)
- urinalysis +/- culture
- flow rate and post void residue
- pad testing
Describe the conservative treatment of incontinence
- pelvic floor exercises
- lifestyle modifications
- biofeedback
- medication; duloxetine (inhibits reuptake of both serotonin and noradrenaline, acts to increase sphincteric muscle activity during bladder filling)
- electrical stimulation of pelvic floor
Describe injection therapy for treatment of incontinence
- the injection of bulking materials into the bladder neck and periurethral muscles to increase outlet resistance
- main indication is for female stress incontinence secondary to demonstrable intrinsic sphincter deficiency in the presence of normal bladder muscle function e.g. macroplastique or teflon
What are the contraindications and complications of injection therapy for treatment of incontinence?
Contraindications;
- UTI
- untreated bladder overactivity
- bladder neck stenosis
Complications;
- temporary urinary retention
- de novo urge incontinence
- UTI
- haematuria
What is retropubic suspension?
- used to treat female stress incontinence predominantly caused by urethral hypermobility
- aim is to elevate and fix the bladder neck and proximal urethra in a retropubic position in order to support the bladder neck
An artificial urinary sphincter is a closed pressurised system with what three components?
- an inflatable cuff placed around the bulbar urethra or bladder neck
- a pressure regulating balloon placed extraperitoneally in the abdomen
- an activating pump in the scrotum or labia majora
