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Flashcards in deck_1556098 Deck (33):
1

What are the main types of urinary incontinence?

Stress urinary incontinenceUrge urinary incontinenceMixed urinary incontinenceOverflow urinary incontinence

2

Why does urinary incontinence occur?

It occurs when the bladder pressure is greater than the urethral sphincter pressure. Either due to:-- detrusor pressure is high-- sphincter pressure is low

3

What is a major factor which helps to maintain continence?

Strength and support of the urethra by the pelvic floor muscles and ligaments.

4

What is urinary incontinence?

The complaint of involuntary leakage of urine. -- has a massive impact on quality of life

5

Describe stress urinary incontinence

the complaint of involuntary leakage on effort or exertion, or on sneezing or coughing

6

Describe urge urinary incontinence

the complaint of involuntary leakage (of urine) accompanied by or immediately proceeded by urgency

7

Describe mixed urinary incontinece

the complaint of involuntary leakage (of urine) associated with urgency and also with exertion, effort, sneezing or coughing

8

Describe overflow incontinence

Retention of urine causing the bladder to swell. Can be low pressure and pain free.

9

What are some risk factors for incontinence?

Pregnancy and childbirthAnatomical abnormalitiesObesityAgeIncreased intra-abdominal pressureUTIMenopauseDrugs-- anything that weakens the pelvic floor muscles

10

What is the most common form of incontinence?

1. Stress urinary incontinence2. Mixed urinary incontinence3. Urge urinary incontinence

11

What is the correlations of age and the incidence of incontinence?

Incidence steadily increases with age

12

What should you find out from the patient's history?

-- Record amount of fluid passed over 2-3 days (helps for categorisation, determine if intermittent or continuous)-- Previous surgery on plelvic floor-- Childbirth

13

What else can cause an increase in frequency of urination?

Intravesicular inflammatory conditionUrinary tract infectionStone in the bladderTumour

14

What would you typically do for an examination for paitents you suspect have incontinence?

Height and weightAbdominal examinationDigital rectal examination-- prostate exam in malesFemales-- external genitalia-- vaginal exam

15

What are some typical investigations?

Urine dipstickBasic, non-invasive urodynamics-- frequency-vol chart-- bladder diary for about 3 days-- post-micturition residual volume for patients with voiding dysfunction

16

What are some other investigations that are not always necessary?

Invasive urodynamics - pressure flow studiesPad testCytoscopy

17

Describe what pressure flow studies measure

Measure abdominal pressureMeasure internal bladder pressureMeasure detrusor pressure (ab pressure minus internal bladder pressure)

18

Give some methods of conservative management

Change fluid intakeLose weightStop smokingDecrease caffeine and fizzy drinks intakeAvoid constipationTimed voiding, have a fixed schedule

19

What is contained incontinence?

Patients who are not suitable for surgery and who have failed conservative or medical management.

20

Give some examples of contained incontinence

--Indwelling catheter, wither urethral or suprapubic-- Sheath device (adhesive condom attached to catheter tubing and bag)-- Incontinence pads

21

What is a specific treatment for stress urinary incontinence?

Pelvic floor muscle training

22

What is a specific treatment for urge urinary incontinence?

Bladder training such as having a schedule of voiding

23

Describe bladder training

Void every hour Must not void in betweenIncrease times between voiding until up to 2-3 hoursUndertake for 6 weeks

24

Describe some pharmacological treatments

Duloxetine-- NA and serotonin uptake inhibitor. Increases activity of external urethral sphincter during filling phase. Is an alternative to surgery and not used a s a first choice. Anticholinergics-- Act on M2 and M3 receptors to reduce contraction of detrusor muscle. Botulinum toxin-- Inhibits ACh at pre-synaptic neuromuscular junction causing targeted flaccid paralysis--Lasts for 3-6 months

25

What are the main permanent surgical interventions for women?

Low tension vaginal tapesOpen retropubic suspension procedureClassic fascial sling procedure

26

Describe low-tension vaginal tapes

Most commonSupport the mid urethra with polypropylene meshIs >90% successful

27

Describe the open retropubic suspension procedure

Correct anatomical position of the proximal urethra and improves urethral supprt

28

Describe the classic fascial sling procedure

Supports urethra and increases bladder outflow resistance. Involved autologous transplantation of the fascia lata or rectus fascia

29

What is a surgical procedure for women which is used for temporary relief of symptoms?

Intramural bulking agents-- improve ability of urethra to resist abdominal pressure -- Inject autologous fat, silicone, collagen or hyaluron-dextran polymers

30

What are the surgical procedures which are used in males?

Artificical urinary sphincterMale sling procedure

31

Describe the artificial urinary sphincter surgery

Cuff is a mechanical device which stimulate the action of a normal sphincter to close the urethra. -- can have problem with infection, erosion and device failure.

32

Describe the male sling procedure

Corrects iatrogenic caused incontinence. Uses a bone-anchored tape in order to support the urethra.

33

What is the normal capacity of the bladder?

300 - 700 ml-- can be more in different people