Genito-urinary tract system Flashcards
(17 cards)
Different types of urinary incontinence
- Urgency incontinence - sudden immediate need to pass urine.
- Stress incontinence - leakage on exertion e.g., lifting, sneezing.
- Mixed incontience - mixed above, but one tends to be predominant.
Risk factors for urinary incontinence
- Elderly
- Pregnancy
- Previous vaginal delivery
- Obesity
- Smoking
- Constipation
- Family history
- Medicines use e.g., diuretics, alcohol, caffeine.
Treatment of urgency urinary incontinence
- Bladder training for minimum 6 weeks
- Antimuscarinic (oxybutynin or tolterodine)
- Mirabegron
Treatment of stress urinary incontinence
- Pelvic floor muscle training for at least 3 months
- Surgery or duloxetine
Treatment of mixed urinary incontinence
- Bladder training for minimum 6 weeks + pelvic floor muscle training for minimum 3 months.
- Follow pathway of whichever predominates
Name 5 antimuscarinics used for urinary incontinence
Fesoterodine
Solifenacin
Trospium
Oxybutynnin
Tolteridone
Antimuscarinics contraindications
- Angle-closure glaucoma
- Gastro-intestinal obstruction
What is nocturnal enuresis
Involuntary urination during sleep i.e., wetting the bed.
Common in children
Management of nocturnal enuresis
Should resolve without intervention in < 5s (do nothing).
1. Reduce fluid intake (4h) and go to the toilet before bed. Use reward systems to encourage this.
2. If no response to advice / 1-2 wet beds per week: enuresis alarm (goes off when wet).
3. Add in / replace with desmopressin
4. Desmopressin +/- antimuscarinic (oxybutynin or tolteridone) (specialist)
5. Imipramine (specialist)
Advice for enuresis alarm
- Recommended 7+, but can be used 5+ depending on maturity, motivation, and understanding.
- Have less relapse than drug treatment when discontinued.
- Review alarm after 4 weeks
- Continue until a minimum of 2 weeks of uninterrupted dry nights
Advice for desmopressin in nocturnal enuresis
- > 5 years
- Can be used if enuresis alarm not appropriate (e.g., if only occurs on holiday, if other small children) or needing rapid results
- Assess treatment after 4 weeks, and continue for 3 months if patient is responding
- Repeated courses should be withdrawn gradually at regular intervals
Causes of urinary retention
- Urethral blockage
- Medication e.g., antimuscarinics, sympathomimetics, TCAs
- Benign prostatic hyperplasia (BPH) i.e., enlarged prostate
What are the types of urinary retention? How are they treated?
- Acute: abrupt development over a period of hours. Medical emergency - immediate catheterisation and give alpha-blocker for 2+ days before removing catheter.
- Chronic: gradual development over months with inability to completely empty bladder. Long-term catheter, but may cause UTIs, pain, and stone formation.
- Chronic due to BPH: alpha-blocker. If pt has raised prostate antigens or is high risk of progression use a 5-alpha-reductase inhibitor.
Name 4 alpha-blockers
Alufozosin
Doxazosin
Tamsulosin
Terazosin
Name 2 5-alpha-reductase inhibitors
Finasteride
Dutasteride
Alpha-blockers adverse effects
- Postural hypotension and dizziness
- First dose hypotension
- Avoid in micturition syncope (fainting) and postural hypotension
Adverse effects fo 5 alpha reductase inhibitors
- Breast disorder e.g., nipple pain, breast tenderness
- Sexual dysfunction
- Male breast cancer
- Cytotoxic - should not be handled by women of childbearing potential
- Teratogenic (and cytotoxic) - excreted in semen - use condom.
- Finasteride MHRA: psychiatric reactions
Finasteride, DUrasteride
