Station 8 Flashcards
Lady comes to clinic complaining of frequency/urgency
Assess
Focused urological history:
Symptoms (Storage FUN, Voiding WISE), Incontinence
- (Duration, onset, triggers)
- Try to quantify incontinence (Pads, etc.)
Impact on QOL
UTI symptoms
History of UTIs
Red Flags - Haematuria, Constant Leak (Fistula), Neurological Symptoms
PMH/PSH
- Gynae
- Plevic Surgery/Radiotherapy
- Neurological
- Urological
- Co Morbidities- ?Fitness
SH:
Smoke
Drink
Excercise tolerance
Occupation
Examine
General - BMI, Fitness,
Abdomen - Bladder/ Loin pain
Pelvic
- Prolapse, Precipitate leak with cough, Urethral Mobility
- Atrophic Vaginitis
- PF Muscle - Awareness and strength
- Palpable masses
- Speculum - Rectocele / Cystocele
Investigate
Validated Questionnaire - ICIQ- UI/ ICIQ - OAB
Bladder diary - 3 consecutive days, output - volume/timing/exacerbating factors, input - volume,timing,content
Urine Dip
FR + PVR
NICE do not recommend routine US / Flexi - Get them if (haematuria, Sterile pyuria, high PVR, deranged renal function, recurrent infections)
UDS if planning for surgery
Treatment options for OAB
Conservative
Weight loss
SMoking cessation
Fluid changes - caffeine/carbonated/alcohol/timing
Bladder Training + Pelvic Floor Muscle Training
Medical
Anti Cholinergic - SE - Dry eye/ Dry mouth/ Constipation/ elderly patients - cognitive decline. CI - uncontrolled closed angle glaucoma, MG, Significant PVR
Mirabegron - headaches. CI - Uncontrolled severe hypertension
Invasive - Should go through PF MDT
Botox
Sacral neuromodulation
PTNS
Bladder Augmentation
Urinary diversion
Consent for bladder botox
Clarify patient details. Explain procedure without jargon and offer alternatives.
Common:
Pain, Bleeding, Dysuria, Further Treatment requires, Non-responder (30%)
UTI (<15%, Recurrent <5%),
Needing to self catheterise (10%)
Allergy to botox, Neurologic phenomena (Weakness in limbs), Anaesthetic risk
