Urology: incontinence Flashcards
What is stress incontinence?
Leaking of urine when intra-abdominal pressure is raised, putting pressure on bladder
What are triggers of stress incontinence?
coughing, laughing, sneezing
what are the RF for stress incontinence?
childbirth and hysterectomy, female, pregnant, chronic cough, smoker, weak pelvic floor
Define urinary incontinence
Involuntary leakage of urine
Name some general risk factors for urinary incontinence
Age, obesity, multiparty, vaginal birth, FHx, being female, PMH of stroke, DM, depression.
What is the PERFECT mnemonic used for pelvic floor examination?
P= Power, E = Endurance, R = Repetition, Fast contraction, ECT = Every Contraction Timed
How does stress incontinence present?
Urine leaks when increase intra abdo pressure e.g cough, sneeze, laugh, exercise, lift.
Woman. Older age. Smoker. Chronic cough may be present. Pregnant or childbirth. Pelvic or prostate surgery. Overweight/high BMI. Hysterectomy.
Describe the pathophysiology of stress incontinence
Intra abdominal pressure exceeds the urethral pressure. Also have weak pelvic floor muscles
What investigations may you do for suspected stress incontinence?
Ask pt to keep bladder diary.
Midstream urine dip.
Examine rectum (for prostate) and bladder.
Urodynamic assessment for detrusor muscle.
Outflow urodynamics. Cystoscopy.
How is stress incontinence managed if pt has visible haematuria or non-visible haematuria?
Urgent 2ww.
What lifestyle advice might you recommend to a pt with stress UI or urge UI?
Reduce caffeine intake, lose weight, advise on fluid intake, stop smoking.
What surgical options are available for stress UI?
Colpususpension, sling surgery, vaginal mesh surgery, urethral bulking agents, artificial urinary sphincter.
How does urge UI present?
High BMI pt, drinks caffeinated drinks. Has PMH of UTIs. Sudden intense urge to pee, followed by involuntary loss of wee. Nocturia. Pass urine during sex, when reaching orgasm.
What is the pathophysiology of urge UI?
Overactive bladder leads to uninhibited bladder contractions. This increases intravesical pressure, causing urine to leak.
How is urge UI managed (non-surgical)?
1)Need to exclude overflow UI. 2) Bladder training. 3) Prescribe antimuscarinic e.g. oxybutynin.
How can urge UI be managed surgically?
Botox injections. Sacral nerve stimulation. Posterior tibial nerve stimulation. Augmentation cystoplasty. Urinary diversion.
Define mixed UI
Stress and urge incontinence
How does overflow incontinence present?
Small trickles of wee. Feel bladder is never empty. Can not empty when try to go. PMh of BPH.
What is pathophysiology of overflow UI?
A complication of chronic urinary retention. Progressive stretching of bladder leads to damage of sacral reflex efferent fibres. Lose sensation of bladder. Bladder fills with urine and becomes distended. Intravesicular pressure builds, so get dribbling of urine out.
What specific investigation may you want to do for suspected overflow UI?
Bladder scans pre and post voiding.
What are surgical options for overflow UI?
Indwelling catheter, Clean intermittent catheter.
How does continuous incontinence present?
Constant dribbling/leaking, needing to wear a pad. Affect daily life.
Describe pathophysiology for continuous UI
Anatomical abnormality (e.g. ectopic ureter) or bladder fistula.
What are complications of using botox to manage urge UI?
May need catheter to drain bladder
Name a complication of a long term catheter?
UTIs!!!
