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M301 > W12 Patho of Urinary Incontinence & Retention (RT) > Flashcards

W12 Patho of Urinary Incontinence & Retention (RT) Flashcards

1
Q

What is Urinary incontinence?

A
  • Involuntary urination
  • Normally continence is possible through:
    -The sphincters of the bladder neck & urethral
    -Detrusor muscle stability
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2
Q

Anatomy of the Urinary Bladder:

A
  • Detrusor muscle (smooth muscle)
  • Ureter
  • Urothelium
  • Uretal orifice
  • Trigone
  • Intermal spincter (Bladder neck)
  • External sphincter (Skeletal muscle)
  • Pelvic floor musculature
  • Urethra
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3
Q

Bladder filling and voiding
When filling.. detrusor muscle/bladder is..

A

The filling and voiding cycle is complex and requires co-ordination between contractile
motions of the bladder and reciprocal motions of the bladder neck

Filling
- detrusor muscle is relaxed
- bladder is closed

Voiding:
- detrusor muscle contracts
- bladder neck opens

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4
Q

Types of incontinence? (4)

A
  1. Urge incontinence
  2. Stress incontinence
  3. Overflow incontinence
  4. Mixed Incontinence
    * Combined urge & stress incontinence
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5
Q

Urge incontinence: Overactive Bladder

A
  • Involuntary voiding & strong urge to urinate
  • Commonest cause = detrusor instability (overactivity) (contracts before bladder is full)
  • Disturbing & embarrassing condition
  • significant impact on quality of life
  • Uncontrollable pressure rises in bladder lumen - lead to a feeling of urgency of micturition
  • if severe enough: urinary incontinence
  • Usually with frequency & nocturia
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6
Q

Causes of Detrusor instability?

A
  • Idiopathic (“spontaneous, obscure or unknown cause”)
    -Supersensitivity (increased excitatory/decreased inhibitory impulses
    -increased electrical connectivity (detrusor muscle fibres)
    -loss of cholinesterase
  • Age
    -neurodegeneration (Stroke, Alzheimers & Parkinson’s disease)
    -muscular degeneration
  • Neurogenic (spina bifida, multiple sclerosis)
  • Obstructive (tumours, benign prostatic hypertrophy)
  • Medications
  • Infections
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7
Q

Parasympathetic System:

A

External Sphincter muscle
Leads to micturition (urination)
Parasympathetic nerves (M2/3 receptors) - ,
muscarinic receptors on smooth muscle wall

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8
Q

What are the class of drug treatment for urinary incontinence?
what is their mechanism of action?
when are effects seen?
how long to remain on treatment?

A

Antimuscarinic drugs:
* Inhibit involuntary contractions of detrusor muscle
* Increase bladder capacity
* Constrict internal sphincter (prevent relaxation)
-Therapeutic effect normally seen in 2-3 weeks
-Patients should remain on treatment for 3-6 months

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9
Q

Examples of antimuscarinic drugs?

A
  • Oxybutynin
  • Tolterodine
    -detrusitol
  • Darifenacin - M3 selective
  • Flavoxate - more selective for M3 than M2
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10
Q

Antimuscarinic side effects and
why do they occur? (3) (not assessed)

A

Why? = muscarinic receptors located other than on bladder
* Dry mouth
-Oral infections
-Small sips of water / artificial saliva
* Constipation
-High fibre diet/lazatives
* Dry eyes
-Artificial tears

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11
Q

Stress incontinence: Stress Urinary Incontinence (SUI)

What is involuntary urine loss caused by?
Who is prone to this?

A
  • Involuntary urine loss caused by:
  • pelvic floor & sphincter incompetence
  • sudden rise in abdominal pressure
    -e.g. exercise, laughing, coughing or standing up
  • Also called “sphincter insufficiency”
  • women after child-birth
  • older women with very high BMI and with
    bladder neck impairment
  • men after prostatectomy - damage to
    external sphincter
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12
Q

Stress Urinary Incontinence
What are the non-drug treatments?

A
  • Reduce fluid intake
  • Weight loss (if obese)
  • Bladder training
  • Pelvic floor exercise
    -wrap quite firmly around urethra, anus vagina etc, help keep them shut and help control bladder, bowel & sexual function
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13
Q

Somatic innervation of Bladder:
what does it do?

A

Voluntary constriction of external sphincter to prevent micturition (Pudendal nerve)

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14
Q

What drug is used to prevent stress urinary incontinence in women?
mechanism of action?

A
  • Noradrenaline (NA) & serotonin (5-HT)
    reuptake inhibitor (SNRI)
  • Antidepressant
    (inc amount of neurotransmitter and sympathetic drive)
    Duloxetine - voluntary constriction of
    external sphincter to prevent micturition
    -enhances effect of of somatic NS
    Increases external sphincter tone
    & contractility
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15
Q

What is Overflow incontinence?
Who does this often occur in?

A
  • Involuntary urination when bladder is full
  • Often occurs following urinary retention
  • Mainly men - benign prostatic hyperplasia (outflow obstruction) e.g. enlarged prostate
  • If the obstruction is serious there can be renal damage
    -relieved by catheterization
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16
Q

Sympathetic “Continence”

A

Constricts Internal Sphincter muscle (external is PS NS)
Relaxes detrusor muscle
-Beta and Alpha adrenoreceptors on bladder wall

17
Q

What is Urinary retention?
how can this be treated if acute?

A

Inability to voluntarily urinate
* Secondary to urethral blockage
* Drug treatment (a1A/B antagonists)

  • Acute – catheterisation
18
Q

α1A/B-adrenoceptor antagonism?
MoA?

A
  1. Work on internal sphincter muscle predominantly
    (Relaxes smooth muscle)
  2. Prostate
    = Improved urine flow
  • Blocking α1A- & α-1B – adrenoceptors
  • Relaxation of smooth muscle in bladder neck & prostate
    -improvement of urine flow
  • Eg Alfuzosin , Terazosin, Doxazosin
19
Q

Summary (for info)

A
  • Bladder is under autonomic and somatic control
  • Urge incontinence
    -Antimuscarinics (e.g. Oxybutinin, Flavoxate)
  • Stress Incontinence
    -SNRI (Duloxetine)
  • Overflow Incontinence / Urinary retention
    -α1-Adrenoceptor antagonists
20
Q

Difference between stress/urge and overflow urinary incontinence?

A

Stress incontinence
Also known as stress urinary incontinence (SUI), this occurs when the urethral sphincter is weakened and urine leaks when abdominal pressure increases. This can happen during physical activity, such as coughing, sneezing, laughing, or lifting something heavy. Leakage can be slight, moderate, or severe.

Urge incontinence
Also known as urgency urinary incontinence (UUI), this occurs when the bladder is overactive and there’s a sudden, intense need to urinate. This can be accompanied by leakage, but it can also be asymptomatic. Other symptoms of an overactive bladder include frequent urination and waking up more than twice at night to urinate

Overflow incontinence:
* Involuntary urination when bladder is full
* Often occurs following urinary retention

M301 (55 decks)

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