ICB - Incontinence Flashcards

1
Q

What is stress incontinence? What investigations would you perform? Outline the management

A

-Leaking small amounts of urine when coughing or laughing

Investigations:

  • MSU
  • Abdo exam
  • Post void bladder scan
  • Genitalia exam (atrophic vaginitis/prolapse)

Management:

  • Pelvic floor exercises (8 contracts TDS for 3/12)
  • Surgery: retropubic mid urethral tape procedures
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2
Q

What is urge incontinence/OAB? What investigations would you perform?

A

-Once desire to pee is felt, the patient can’t resist (toilet mapping) - due to detrusor over-activity

Investigations:

  • Routine: bladder diary (3 days), PV exam, urine dip and MSU
  • Urodynamics
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3
Q

Outline the management of OAB/urge incontinence

A

Management

  • Bladder training: minimum 6 weeks
  • Improving oral intake of fluids
  • Reduce caffeine consumption
  • Anti-muscarinics: oxybutynin (immediate release but avoid in older frail pts), tolterodine, mirabegron (better in older/frail patients)
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4
Q

What is overflow incontinence? Investigations and management?

A

-Obstruction causing retention and then leakage of urine - small continuous dribble (due to bladder outlet ouflow - eg in BPH)

Investigations

  • Bladder scan
  • R/w causes of retention: PR, abdo exam

Management
Relieve obstruction: eg laxatives or BPH mx

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5
Q

What is functional incontinence? Investigations? Management?

A

-Incontinence on the way to the bathroom - something obstructing the way

Investigations:
-Rule out other causes for recention/incontinence and check home environment

Management
-Change home set up - eg toilet closer to bed

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6
Q

What is mixed incontinence?

A

Urge and stress incontinence

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7
Q

Oxybutynin: class of drug, indications for use and side effects

A
  • Anti-muscarinic
  • Indication: urge incontinence,frequnecy, urgency, neurogenic bladder instability
  • SEs: constipation, dizziness, drowsiness and dry mouth
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8
Q

Mirabegron: class of drug, indications for use and side effects

A

-B3 adrenergic agonist
-Indication: urge incontinence, frequnecy, urgency
-SEs: arrhythmias, constipation, dizziness, diarrhoea, headache
*Used preferentially in older patients with UI in order to spare them anti-cholinergic burden

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9
Q

Tolteradine: class of drug, indications for use and side effects

A
  • Antimuscarinic
  • Use: UI, frequnecy, urgency, neurogenic bladder instability
  • SEs: constipation, dizziness, drowsiness and dry mouth
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10
Q

Tamsulosin: class of drug, indications for use and side effects

A
  • Alpha 1 adrenoreceptor antagonist
  • Use: BPH urinary outflow obstruction
  • SEs: dizziness, sexual dysfunction/ejaculation issues
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11
Q

Doxazosin: class of drug, indications for use and side effects

A
  • Alpha 1 adrenergic blockers
  • Use: BPH urinary outflow obstruction (improves peak urinary flow), HTN
  • SEs: arrhythmias, dizziness, cystitis
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12
Q

Finasteride: class of drug, indications for use and side effects

A
  • 5 alpha reductase inhibitors - blocks testosterone production (which stimulates prostate and causes BPH)
  • Use: BPH
  • SEs: impotence, loss of libido, dizziness
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