Women's health- Urogynaecology Flashcards
what shape would an overactive bladder have in a contrast scan
in extreme cases it would be like a christmas tree
diverticula can appear to give a ‘baubled’ appearance
vesicoureteric reflux may be present
what lifestyle adaptation is recommended for overactive bladder or urinary incontinence
weight loss
smoking cessation
reduced caffeine intake
avoiding of straining and constipation
what can be prescribed to reduce UTI
Hiprex (increases acidity of the urine)
Oestrogen
treatment of bowel conditions
self testing of urine
what is used to manage incontinence
catheterisation
leakage barriers
vaginal support (pessaries)
skin care
HRT (vaginal oestrogen)
lifestyle adaptation
what are options for catheterisation
indwelling
- suprapubic or urethral
- bag or flip flow valve
Clean intermittent self catheterisation (CISC)
- in and out catheter
describe the detrusor
smooth muscle
transitional epithelium
normally contracts only during micturition
describe the detrusor in overactive bladder
involuntary detrusor contractions
reflex bladder activity
urgency and urgency incontinence
how is the detrusor innervated
sacral parasympathetic
which neurotransmitter is responsible for detrusor action
Acetylcholine
which receptors are present in the detrusor
muscarinic: M2 and M3
what antagonises the action of the NT on the detrusor
Anticholinergics
Atropine like agents (oxybutynin, Tolterodine, Solifenacin, Trospium)
what are the issues with using anticholinergics long term
crosses the blood brain barrier and causes cognitive impairment
what is the alternative treatment for overactive bladder than anticholinergics
Mirabegron
Mechanism of Action
Beta-3 adrenergic receptor agonist
Relaxes smooth muscle detrusor
Increases bladder capacity
how does botox work in treating overactive bladder
blocks acetylcholine release
what is the main treatment for stress incontinence
physiotherapy for pelvic floor exercises
up to 60% success rate
biofeedback, electrical stimulation, vaginal cones (kegels)
