Altered voiding

Question 1

Mechanisms which normally prevent reflux of urine into the kidey

Answer 1

Vesicourethral angle

Urinary sphincters

Question 2

Storage lower urinary tract symptoms

Answer 2

Incontinence
Urgency
Frequency
Nocturia

Question 3

Voiding lower urinary tract symptoms

Answer 3

Poor stream
Hesitance
Dysuria
Intermittency
Terminal dribbling

Question 4

Management for voiding (obstructive) urinary symptoms

Answer 4

Conservative: advice, behaviour modification
Medical: alpha blockers, 5-alpha reductase inhibitors (inhibits testosterone, reduces prostate size. Common cause of symptoms in men)

Question 5

Management for storage urinary symptoms

Answer 5

Conservative: advice e.g. drink less coffee, reduce fluid load, bladder retraining, pelvic floor exercises
Medical: alpha blockers, anticholinergics, beta3 agonists

Question 6

Types of urinary incontinence

Answer 6

Stress incontinence
Urge incontinence
Overflow incontinence
Functional incontinence
Continuous incontinence

Question 7

Stress incontinence

Answer 7

Involuntary urine leakage on effort or exertion e.g. coughing. Rise in intrapelvic pressure leads to leakage because of poor sphincter resistance.

Common in middle aged females, after child breaking bladder neck is hypermobile

Treat with pelvic floor exercises, topical oestrogens or surgery

Question 8

Urge incontinence

Answer 8

Involuntary urine leakage accompanied or immediately preceeded by urgency. Abrupt desire to void cannot be controlled.

Commonest in >75
Can be due to infection, tumour, stones, stroke, dementia

Treatments include bladder retraining, avoiding stimulants, can use anticholinergics, b3 agonists or botox. Surgery

Question 9

Overflow incontinence

Answer 9

Prolonged problems with bladder emptying lead to detrusor failure and chronic retention. Pressure eventually rises due to overdistension of the tissue, causing leakage. Normally occurs at night

Treat by restoring bladder emptying e.g. intermittent self-catheterisation, long term catheter, surgical treatment of obstruction.

Question 10

Functional incontinence

Answer 10

Incontinence due to cognitive impairment or mobility problems that prevent use of the toilet. Bladder function is normal.

Question 11

Continuous incontinence

Answer 11

Leakage occurs continuously. Is not related to bladder sensation or other events.

Due to a fistula between the urinary tract and skin, duplex kidney where the ureter inserts below the external sphincter, stoma bag.

Treatment requires surgery to fix the underlying cause

Question 12

How does outflow tract obstruction affect detrusor activity and voiding

Answer 12

Outflow tract obstruction results in an under active detrusor muscle. Results in overflow incontinence.

Question 13

Describe the techniques of urodynamics

Answer 13

Assess the function of the bladder and urethra. Recommened if LUTS are persistent.

Frequency volume charts for 24 hrs
Urinary flow rate: measures the quantity voided per unit time.
Post-void residual measurement:
Pressure-flow study

Question 14

Urodynamic assessment

Answer 14

Catheter passed into the bladder and a transducer to the rectum. Bladder if filled with fluid and the pressure in the bladder and rectum are recorded. The difference between them tells you the detrusor pressure. The catheter is then withdrawn and the urine flow rate is measured with detrusor pressure.

High pressure and low flow rate indicates obstruction

Spontaneous increases in pressure indicate hyperactivity.

Increase in pressure at the end of filling indicates poor compliance. Causes urge incontinence when the bladder is full.

Rise and fall in pressure during filling is caused by detrusor instability.