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Urinary System > Week 8 - Urinary Incontinence > Flashcards

Week 8 - Urinary Incontinence Flashcards

1
Q

How is the detrusor muscle of the bladder controlled?

A

Parasympathetic S2,3,4 (pelvic nerves)

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2
Q

How is the sphincter of the urethra controlled?

A

Somatic pudenal nerve S2,3,4

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3
Q

Describe the filling/storage phase of bladder function?

A

Receptive relaxation/compliance
Sensation of bladder filling
No detrusor contraction

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4
Q

Describe the voiding phase of bladder function?

A

Voluntary initiation

Complete emptying

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5
Q

Describe problems of bladder function due to lower motor neurone lesion?

A

Low detrusor muscle pressure (don’t contract as much)
Large residual volume as cant fully empty
May have overflow incontinence
Reduced perianal sensation
Lax anal tone
S2,3,4 affected

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6
Q

Describe problems of bladder function due to upper motor neurone lesion?

A

High pressure detrusor contractions which causes dilated ureters
Thickened detrusor
Poor contraction of sphincters - detrusor sphincter dyssynergia

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7
Q

What are the classifications of lower urinary tract symptoms (LUTS)?

A

Storage
Voiding
Post-micturition

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8
Q

What come under storage problems of LUTS?

A

Frequency
Urgency
Nocturia
Incontinence

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9
Q

What comes under voiding problems of LUTS?

A 
Usually caused by blockage
Slow stream
Splitting/spraying
Intermittency
Hesitancy
Straining
Terminal dribble
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10
Q

What are the post-micturition problems of LUTS?

A

Most-micturition dribble

Feeling of incomplete emptying

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11
Q

What is stress urinary incontinence (SUI)?

A

Involuntary leakage on effort or exertion or on coughing or sneezing

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12
Q

What is urge urinary incontinence (UUI)?

A

Involuntary leakage accompanied by or immediatly proceeded by urgency

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13
Q

What is mixed urinary incontinence (MUI)?

A

Involuntary leakage associated with urgency and exertion, effort, sneezing or coughing

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14
Q

Name some risk factors of urinary incontinence?

A 
Pregnancy and childbirth
pelvic prolapse
menopause
neurological abnormalities
Obesity
Age
uTI
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15
Q

What investigations might you do in a patient with urinary incontinence?

A

Urine dipstick
Frequency-volume chart
Pad tests

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16
Q

What lifestyle interventions may be used to help someone with urinary incontinence?

A 
Modify fluid intake
Weight loss
Stop smoking
Decrease caffeine intake (especially in UUI)
Avoid constipation
Timed voiding
17
Q

If a patients still having trouble but they’re not suitable for surgery, what can we do?

A

Indwelling catheter
Sheath device
Incontinence pads

18
Q

How can SUI be treated without medication?

A

Pelvic floor muscle training

8 contractions 3 times a day for at least 3 months

19
Q

What medication can be used to treat SUI?

A

Duloxetine - combined noradrenaline and serotonin uptake inhibitor, increases activity in striated sphincter during filling phase

20
Q

In a female how can SUI be treated surgically?

A

Permanent - low tension vaginal tapes, retropubic suspension procedures, classical sling procedures
Temporary (if further pregnancies planned) - intramural bulking agents

21
Q

In a male how can SUI be treated surgically?

A

Artificial urinary sphincter

Male sling procedure

22
Q

How do low tension vaginal tapes work?

A

Supports mid urethra with polypropylene mesh

23
Q

How do retropubic suspension procedures work?

A

Correct anatomical position of proximal urethra and improve urethral support

24
Q

How do classical sling procedures work?

A

Supports urethra and improves bladder outflow resistance

25
Q

How do intramural bulking agents work?

A

Improve ability of urethra to resist abdominal pressure by improving urethral coaptation

26
Q

How does a male artificial urinary sphincter work?

A

Used in urethral sphincter deficiency

Cuff stimulates action of normal sphincter to circumferentially close the urethra

27
Q

What is the initial management of UUI?

A

Bladder training - schedule of voiding, must wait or leak but not void between times
Gradually increase intervals for at least 6 weeks

28
Q

What is the phamacological managment of UUI?

A

Anticholinergics - act on muscarinic receptors (M2 and M3)
Lots of side effects as M receptors at other sites e.g. Cardiac muscle, smooth muscle, salivary glands, CNS

Beta3 adrenoceptor agonist - increases bladder capacity to store urine

Urinary System (24 decks)

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