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Year 3 - Repro and Anaesthetics > Female Urinary Incontinence > Flashcards

Female Urinary Incontinence Flashcards

1
Q

The urinary tract consists of 2 mutually dependant components - what are they?

A

Upper tract (Kidneys & Ureters):

  • A low pressure distensible conduit with intrinsic peristalsis
  • Transport urine from nephrons via ureters to the bladder.

Lower tract (Bladder & Urethra):

  • The bladder fills at rate of 0.5-5 mls/min
  • A low-pressure storage of urine
  • Efficient expulsion of urine at appropriate place & time
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2
Q

what is the Vesico-ureteric mechanism?

A

protects the nephrons from any damage secondary to retrograde transmission of back pressure or infection from the bladder

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3
Q

what is the bladders nevre supply?

A
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4
Q

Bladder filling:

Accommodate increasing volume at constantly ___ pressure

Inhibition of contractions by giving rise to gradual __________ of filling

Cortical activity: Activating a reciprocal guarding reflex by Rhabdosphincter contraction; increase sphincter contraction & resistance:

  • Activates __________ pathway &
  • Reciprocal inhibition of the ___________ pathway
  • Mediates _________ of bladder base and proximal urethra
A

low

awareness

Sympathetic

Parasympathetic

contraction

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5
Q

what is involved in bladder emptying?

A

Detrusor contraction

Urethral Relaxation

Sphincter co-ordination

Absence of Obstruction or anatomical shunts (Cystocele, Diverticulum)

Cortical Influence (Pontine micturition centre) - Activation of parasympathetic pathway & Inhibition of Sympathetic pathway

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6
Q

what is the definition of urinary incontinence (UI)?

A

any involuntary leakage of urine

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7
Q

what is the definition of stress urinary incontinence (SUI)?

A

involuntary leakage on effort or exertion, on snezzing or coughing

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8
Q

what is the definition of urge urinary incontinence (UUI)?

A

invuluntary leakage acompanied by or immediatley preceded by urgency

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9
Q

what is the definition of mixed urinary incontinence (MUI)?

A

involuntary leak acoompanied by or immediatley preceded by urgency and on effort or exertion, or on sneezing or coughing

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10
Q

what is the epideimology of incontience

A

10-25% of women age 15-60 report urinary incontinence

15-40% of women over age 60 in the community report incontinence

More than 50% of women in nursing homes are incontinent.

W.H.O. recognizes incontinence as an international health concern

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11
Q

what is the impact of UI?

A

UI may significantly impair the QoL

Reduce social relationships and activities

Impair emotional and psychological well-being

Impair sexual relationships

Embarrassment and diminished self-esteem

It is due to the impact of UI on women ’ s QoL that medical help is sought however after many years of suffering (average 5 years)

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12
Q

what are the risk factors for UI?

A
  • Age
  • Parity
  • Menopause
  • Smoking
  • Medical problems
  • ­Increased Intra abdo pressure
  • Pelvic floor trauma
  • Denervation
  • Connective tissue disease
  • Surgery
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13
Q

what is the main risk factor for SI?

A

pregnancy and childburth

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14
Q

how is a patient assessment done?

A
  • History
  • Examination
  • Investigations
  • Management
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15
Q

what should be asked in a history?

A

Age, parity, mode of deliveries, weight of heaviest baby, Smoking, HRT,

Medical Conditions: DM, anti-HTN medications, Glaucoma, Heart/Kidney/Liver problems, Cognitive problems, Anti-depressants/ anti-psychotics.

Previous PFMT, Surgical treatment of SUI or POP

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16
Q

Patient Assessment - Complaint:

what are some irritaiton symptoms?

A

Urgency; Sudden compelling desire to void that is difficult to defer

Increased daytime frequency (>7)

Nocturia (>1)

Dysuria

Haematuria

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17
Q

Patient Assessment - Complaint:

what are some incontinence symptoms?

A

Stress UI

Urgency UI

Coital Incontinence

Severity: How many pads/day?

18
Q

Patient Assessment- Complaint:

what are some voiding symptoms?

A

Straining to void

Interrupted flow

Recurrent UTI

19
Q

Patient Assessment- Complaint:

what are prolapse symptoms and also what are some bowel symptoms?

A

Prolapse Symptoms: Vaginal Lump/Dragging sensation in vagina

Bowel symptoms: Anal Incontinence, Constipation, faecal evacuation dysfunction, IBS

20
Q

for a patient assessment you can do a 3 days Urinary Diary, what does this record?

you can also do a urine dipstick aswell

A

Fluid intake: Quantity & Quality

Urine Out-Put (exclude Nocturnal Polyuria)

Daytime Frequency,

Nocturia

Average voided volume

21
Q

Examination of the women with Bladder/Pelvic floor problems

what different areas are exmained?

A

General

Abdominal

Neurological

Gynaecological

Pelvic floor assessment (Oxford Scale)

22
Q

Examination of the women with bladder/pelvic floor problems - what thing smay you think/be invesitgating?

A

Prolapse

Stress incontinence

Uro-genital atrophy changes

Pelvic mass (space occupying leasion)

Pelvic floor tone, strength, awareness

23
Q

what investigaitons can be done?

A
  • Urinalysis: Multistix +/- MSSU
  • Post voiding residual volume assessment (usually by bladder scanning) only If symptoms of voiding difficulties
  • Urodynamics: ONLY indicated if surgical treatment is contemplated:
  • Measures flow rate (Q) of urine in ml/s
  • Flow rate is dependent on the urethral resistance, strength of detrusor contraction and abdominal straining
24
Q

what managment is used?

A

Lifestyle changes

Medical treatments

Physiotherapy

Surgery

25
Q

what causes stress incontinence and what can help it?

A
26
Q

what lifestlye changes can help incontinence?

A

Stop smoking

Lose weight

Eat more healthily to avoid constipation

Stop drinking alcohol and caffeine

27
Q

conservative treatment of UI - whos hould recieve it?

A
28
Q

how does pelvis floor muscle training (PFMT) help?

A
29
Q

what pharmacological treamtent is used for SUI?

A
30
Q

who should receive duloxetine?

A
31
Q

what is colposuspension?

A

Colposuspension is an operation to treat stress incontinence in women

In colposuspension, your surgeon lifts the neck of your bladder into the correct position and holds it in place with stitches. This helps to prevent urine from leaking.

32
Q

“Integral Theory Of Female UI”:

Both Stress and Urge incontinence arise from the same anatomical defect in the _______ vaginal wall & __________ ligament (PUL) - Urethral/bladder neck closure dysfunction and USI

Suburethral Hammock _____ might result in stimulation of bladder neck _______ receptors, provoking a premature micturition reflex and Urgency Incontinence

A

anterior

pubo-urethral

laxity

stretch

33
Q

Mid-urethral Slings
Retro-pubic TVT

what is TVT?

A

Tension-free vaginal tape (TVT) was introduced into clinical practice by Ulmsten in 1996 as a minimally invasive procedure to reinforce the structures supporting the urethra

Depends on the “Hammock theory” for continence

80% Cure at 11 years follow-up

Polypropylene permenant Synthetic Tape; Monofilament & Macro-porous

34
Q

RCT: TVT Vs Colposuspension - which is better?

A

TVT is as effective as Colposuspension for the treatment of primary USI up to 2 years.

81% Vs 80% Objective cure rates

43% Vs 37% Subjective Cure rates

Less Operative & Postoperative Morbidity

35
Q

TVT has NOW ________ the Colposuspension as the First Choice procedure in the Surgical Treatment of SUI

A

replaced

Efficacy: Long-term results (8 year outcome): 80% cure rate

36
Q

what is Overactive Bladder Syndrome (ICS Definition)?

A

A symptom complex usually, but not always, related to urodynamically demonstrable detrusor overactivity (DO)

Defining symptoms: urgency (with/without urgency incontinence), usually with frequency and nocturia

OAB syndrome occurs in both sexes and at all ages (including children)

Prevalence of OAB increases with age, and is slightly higher in women

OAB results in significant social, psychological, occupational, domestic, physical, and sexual problems

the bladder, which is a bag made of muscle, squeezes (contracts) suddenly without you having control and when the bladder is not full. OAB syndrome is a common condition where no cause can be found for the repeated and uncontrolled bladder contractions

37
Q

what are the symptoms of OAB (overactive bladder)?

A

Urgency: The complaint of a sudden, compelling desire to pass urine that is difficult to defer

Urge incontinence: The complaint of involuntary leakage of urine accompanied or immediately preceded by urgency

Frequency: Usually accompanies urgency with or without urge incontinence and is the complaint by the patient who considers that he/she voids too often by day

Nocturia: Usually accompanies urgency with or without urge incontinence and is the complaint that the individual has to wake at night one or more times to void

38
Q

what are the Risk Factors for Urge Incontinence?

A

Advanced age

Diabetes

Urinary tract infections

Smoking

OAB is a chronic condition therefore Symptoms may wax and wane

39
Q

what is OAB Management?

A
  • Treat symptoms
  • No immediate cure
  • Multidisciplinary approach
  • Requires dedicated team
40
Q

what is OAB Conservative management?

A

• Life style interventions:

  • Normalise fluid intake
  • Reduce caffeine, Fizzy drinks, Chocolate
  • Stop Smoking
  • Weight loss

• Bladder training programme: Timed voiding with gradually increasing intervals - Continence nurse

41
Q

what are osme recent advances?

A

Year 3 - Repro and Anaesthetics (50 decks)

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