Bladder and urinary disorders Flashcards
(20 cards)
What is the treatment for acute urinary retention?
catheterisation + alpha blocker (for at least 2 days)
- alfuzosin, doxasozin
What are the treatment options for urinary retention?
neostigmine
pyridostigmine bromide
What are the types of incontinence?
urinary - involuntary leakage of urine
stress - involuntary leakage on effort or exertion: sneezing, coughing, loss of pelvic floor support/damage to urethral sphincter
urgency - involuntary leakage which is accompanied, or immediately preceded by a sudden compelling desire to pass urine that is difficult to delay
mixed - urgency + stress
overflow - cannot empty their bladder completely and it becomes over distended
What are non-drug treatment options for urinary incontinence?
modify fluid intake
lose weight: if their BMI is 30 kg/m² or greater
reduce caffeine intake (overactive bladder)
What are the non-drug treatment options for urgency incontinence?
1st line - bladder training for at least 6 weeks
What are the non-drug treatment options for stress incontinence?
supervised pelvic floor muscle training for at least 3 months - include at least 8 contractions performed 3 times per day
What are the non-drug treatment options for mixed incontinence?
bladder training for at least 6 weeks and supervised pelvic floor muscle training for at least 3 months, which should include at least 8 contractions performed 3 times per day
What are the drug treatment options for urgency incontinence?
anti-cholinergic or beta 3 agonist (DOTM)
1st line - immediate release oxybutynin, tolterodine or darifenacin
2nd line - new anticholinergic, adjust dose or mirabegron
other options - festerodine, propiverine, solifenacin, trospium, MR oxybutynin, MR tolterodine
3rd line - botulinum toxin type A
When is mirabegron used for urinary incontinence?
if treatment with an anticholinergic is contraindicated, ineffective, or not tolerated
What medications should NOT be used for urinary incontinence?
flavoxate
propantheline
imipramine
What medication can be used for nocturia?
desmopressin
- increase water re-absorption and reduce urine production
What is the drug treatment for stress incontinence?
1st line - supervised pelvic floor muscle training for at least 3 months - include at least 8 contractions performed 3 times per day
2nd line - duloxetine
How is mixed incontinence treated?
treat according to the predominant type
- urgency or stress
What are non-drug treatment options for pelvic organ prolapse?
minimise heavy lifting
prevent/treat constipation
if their BMI is 30 kg/m² or greater - encourage them to lose weight
What are the treatment options for nocturnal enuresis in children?
non-drug: restrict fluid intake at night, diet toileting behaviour
1st line: enuresis alarm (before drug treatment)
drug: desmopressin or imipramine
How does a enuresis alarm work? Who is it given to? How is it monitored?
> 7 years old
given if they wet the bed > 1-2/week
review after 4 weeks
continue until they reach a minimum of 2 weeks without bed wetting
if it fails: add desmopressin
When is desmopressin CI?
< 5 years old
concomitant diuretic use
history of hyponatraemia
What are the side effects of desmopressin?
hyponatraemia
nausea
headache
What monitoring is needed for desmopressin?
weight: fluid overload
blood pressure
What are the counselling points for desmopressin?
risk of hyponatraemic convulsions: avoid fluid overload
stop if vomiting or diarrhoea: risk of sodium loss
