Continence Management Flashcards

Question

describe intraveseical botox

Answer 1

Injection of Botulinum Toxin Type A Neurotoxic - Paralysis of detrusor muscle More effective in pts who failed anti cholinergics due to S/E rather than in those it was ineffective 60% symptom improvement Repeat injection 6 – 12 months Rarely Ab’s form against BTX – confering resistence ISC – 20%

Answer 2

Behavioural therapy (60%-80%) - Dietary modification - Fluid management - Bladder drill/bladder training –individual programmes- Pelvic floor exercises, biofeedback etc Pharmacotherapy - Anticholinergic therapy (60% “dry”) - Surgical management  Intravesical botox  Cystodistension - Bladder augmentation  Autoaugmentation (>90% success) - Clam cystoplasty - TVT/TOT for SUI – mesh treatment now stopped in Scotland - Urinary Diversion

Answer 3

Outflow obstruction – Prostate Frequent voids small amounts Hesitancy (difficulty in initiating the flow) Poor flow rate and post micturition dribble • Frequency, urgency, nocturia, dribbling, can occur if residual large • Detrusor sphincter dysinnergia- neurological impairment causing failure to coordinate bladder contraction with urethral relaxation

Answer 4

Irritative – frequency, urgency urge nocturia Obstructive - hesitancy weak stream straining prolonged micturition post mictural dribble incomplete emptying Other assoc.symptoms- dysuria haematuria and haemospermia

Answer 5

UTI inflammatory response to urothelium to bacterial invasion  The inflammatory response causes a cluster of symptoms such as pain, bladder infection (cystitis) resulting in small frequent voids, urgency, suprapubic pain, urethral burning on voiding (dysuria)

Answer 6

fever chills malaise loin pain and associated with LUTS

Answer 7

bacteria in urine can be asymptomatic or symptomatic if no pyuria indicates bacteriuria colonization of the urine rather than active infection

Answer 8

presence of white blood cells in the urine

Answer 9

An uncomplicted UTI women respond quickly to a short course of antibiotics. E COLI GRAM NEG BACILLUS 85% OF COMMUNITY ACQUIRED AND 50 % HOSPITAL ACQUIRED INFECTION ALSO PROTEUS MIRABILIS, KLEBSIELLA A complicated UTI results in the patient has DSD,or BOO or renal or bladder stones.E COLI, STREPTOCOCCUS FAECALIS OR STAP AUREUS

Answer 10

isolated, recurrent, unresolved isolated = an interval of six mths of last infection Recurrent >2 in the month or 3 in 12 mths Recurrent maybe reinfection by different bacteria or bacterial resistance calculi ( infected prostate prostatitis) Unresolved implies inadequate therapy

Answer 11

``` Female sex  Increasing age  Menopause  Diabetes  Previous UTI  Catheters  And voiding dysfunction ```

Answer 12

Commensal flora Mechanical integrity of mucous membranes Urinary immunoglobulin inhibits bacterial adherence Mechanical flushing of urine through urinary tract Mucopolysacharide coating on bladder Low PH high osmolarity

Answer 13

Renal ultrasound  Flexible cystoscopy  If no functional abnormality found female patients need to be managed by -  Avoid spermicides used with diaphragm or condom  Oestrogen replacement for post menopausal loss of vaginal lactobacilli increased colonisation of Ecoli  Low dose antibiotics prophylaxis given at bedtime 6- 12mths  Trimethroprim  Nitrofurantoin  Cefalexin 250mg nightly  Ciprofloxacin  Natural yogurt  Post coital antibiotic  Self start therapy

Answer 14

To exclude lesions in the urethra and bladder. The bladder neck is examined. It should close in response to straining. However, it opens in case of stress urinary incontinence.

Answer 15

Medical science concerned with the study of urine transport from kidney to bladder as well as its storage and evacuation  Classification: 1.Cystometrogram( most important test), Filling Cystometry and Voiding Cystometry 2.Urethral pressure profile 3.Uroflow 4.Electromyography

Answer 16

It records the rate of urine flow through the urethra when the patient is asked to void spontaneously while sitting on uroflow chair. It is used to evaluate patients with stress incontinence before surgery to exclude difficulty in voiding which may be increased by bladder neck surgery. Also for men with BOO

Answer 17

Postvoid residual is an easy initial test to obtain. After the patient voids, there should be less than 50 ml of urine in the bladder. Postvoid residual is measured by ultrasound or in /out catheter  A patient with an elevated Postvoid residual (repeat measurements greater than 150 ml) may have an underlying neurologic disorder suggesting voiding dysfunction

Answer 18

Duration, severity, symptoms, previous treatment, medications, GU surgery 3 P’s: Position of leakage (supine, sitting, standing), Protection (pads per day, wetness of pads), Problem (quality of life) Bladder record or diary

Answer 19

Stress test (diagnostic for stress incontinence; specificity >90%) Post-void residual Blood Tests (calcium, glucose, BUN, Cr) Urine Culture Simple Cystometrics

Answer 20

1) adequate bladder emptying 2) avoid ladder relaxing drugs 3) refer to urology 4) overflow UI likely

Answer 21

Painless haematuria needs investigated urgently – suggests tumour OR TB Dipstix confirm by microscopic MSU PAIN SUGGESTS INFLAMMATION OR INFECTION BLEEDING AT START OF STREAM URETHRA OR PROSTATE TOTAL HAEMATURIA START TO END STREAM = UPPER URINARY TRACT BLADDER AT END OF STREAM = PROSTATE /BLADDER CAN BE REFERRED TO UROLOGY HAEMATURIC CLINIC

Answer 22

Eliminate the symptoms of frequency urgency and urge incontinence Start with the least invasive treatment Should there be a combination of behavioural and pharmalogical intervention at the outset? Establish realistic treatment goals Patients should be offered only evidence based treatments Behavioural interventions form the key part of any nurse led clinic The nurse makes the clinical decision when to use them Programmes and structures need to be in place to support them Nurses need to demonstrate competencies in each behavioural domain Treatment that will focus on patient characteristics - beliefs about treatment respond to patient goals and preferences Targeted, tailored and individualised move beyond the practitioner centered thinking - treatment is whatever it means to the patient research has shown that there is special patient meaning and response to what a practitioner wears as well as manner, style and language the practitioner uses to interact  Concordance/compliance Do I assess their knowledge and attitudes? Do I chose my other attitudes and words? Do I deliver a programme using my skills to stay on their agenda ? Do I deliberately reduce their anxiety? Do I summarise plans, next steps and reassure the patient? Do I reflect post clinic visit?

Answer 23

 Hypnotherapy reported to have had 86% subjective and 50% objective cure rate (Freeman and Baxby 1982) High relapse rate  Acupuncture 76% Phillip et al 1988 lack of controlled trials due to difficulty in creating a placebo effect.  Only one RCT published that stated women receiving 4 weekly bladder specific acupuncture treatments had significant improvement in bladder capacity, urgency, frequency and qol compared with placebo (2005)  TENS sites include thigh and abdomen no RCT but subjective improvement (1998)  Post tibial nerve stimulation near medial malleus 10-12 weeks duration 30 mins session reported 67-81%  Recent study on refractory OAB treated for 10 weeks reported complete resolution of symptoms 54% with significant improvement in urgency and quality of life measures effect maintained up till 1yr in 23%  But more studies required poor evidence for above

Continence Management Flashcards

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