Incontinence and retention

Question 1

Female urinary bladder can store:

Answer 1

350 ml

Question 2

Male urinary bladder can store:

Answer 2

450 ml

Question 3

Histology of urinary bladder:

Answer 3

Outer adventitial layer: connective tissue
Middle smooth muscle: detrusor muscle
Inner: transitional epithelium

Question 4

Mictuition is controlled by:

Answer 4

Pontine micution center

Question 5

The sympathetic nervous system acts to:

Answer 5

Retain urine: relax detrusor, contract internal sphincter

Question 6

The parasympathetic nervous system acts to:

Answer 6

Urinate: contract detrusor

Question 7

Nerves involved in mictuition:

Answer 7

• Pelvic afferent (sensory)
• Pelvic nerve (PS)
• Hypogastric (S)
• Pudendal (Somatic)

Question 8

Receptors involved in mictuition:

Answer 8

M3, B3, a1, nicotinic

Question 9

External urethral spincter is:

Answer 9

Skeletal muscle, under voluntary control

Question 10

Pelvic and pudendal nerves come from which level of the spinal cord?

Answer 10

S2-S4

Question 11

Test to look at problems filling and emptying bladder:

Answer 11

Cystometry

Question 12

Cystometry measures pressures in what:

Answer 12

• Rectum
• Bladder
• Intrinsic bladder pressure (bladder - rectum)

Question 13

Pressure measurements are measured in synchronicity with:

Answer 13

Flow rate

Question 14

BPH =

Answer 14

Benign prostatic hypertrophy

Question 15

BOO =

Answer 15

Bladder outflow obstruction

Question 16

Types of male lower urinary tract symptoms:

Answer 16

• Voiding

- Storage

Question 17

Voiding symptoms:

Answer 17

Weak, intermittent stream
Staining
Hesitancy
Incomplete emptying
Terminal dribble

Question 18

Storage symptoms:

Answer 18

• Frequency
• Urgency
• Nocturia
• Incontinence

Question 19

What is common in men but uncommon in women?

Answer 19

Voiding difficulty

Question 20

Causes of voiding difficulty:

Answer 20

Increased outflow resistance from obstruction at bladder neck or prostate
Detrusor muscle failure (less likely)

Question 21

Detrusor muscle failure can be primary or secondary to…

Answer 21

Bladder outflow obstruction

Question 22

What hormone is though to be involved in cell hypertrophy of prostate?

Answer 22

Dihydrotestosterone

Question 23

5 a reductase =

Answer 23

Converts testosterone into DHT

Question 24

What may you see on cystometry of BPH:

Answer 24

Pressure double and only manages to pass half the flow

Question 25

Acute urinary retention =

Answer 25

Painful inability to void with relief of pain following bladder drainage

Question 26

Diagnosis of urinary retention:

Answer 26

volumes between 500-800 ccs

Question 27

BOO and retention in women in:

Answer 27

Rare, usually has a urogenic cause

Question 28

Zones of the prostate:

Answer 28

Peripheral, central, transitional

Question 29

Complications of BPH:

Answer 29

``` Obstruction - retention Overflow incontinence Bladder stones Kidney damage Increased risk of infection ```

Question 30

Causes of retention:

Answer 30

- Urethral obstruction | - Neurological

Question 31

Treatment of retention

Answer 31

Intermitted self-catheterisation In-dwelling catheter Alpha blockers, phytotherpay

Question 32

Phytotherapy =

Answer 32

Use of plant-derived medications in treatment

Question 33

Alduzosin hydrocholrise, dozazosin, tamsulosin, prazosin :

Answer 33

Alpha blockers

Question 34

MoA of Tamsulosin:

Answer 34

Blocks alpha receptor on sphincter - relaxes sphincter

Question 35

Ex of 5ARI:

Answer 35

Finasteride

Question 36

Alpha blockers work to:

Answer 36

- Improve symptoms

Question 37

4ARIS work to:

Answer 37

Reduce symptoms and prevent progression

Question 38

Onset of symptoms relief with BPH meds:

Answer 38

1-2 weeks with alpha blockers, longer with 5ARIs

Question 39

TUIP =

Answer 39

Transurethral incision of prostate

Question 40

TURP =

Answer 40

Transurethral resection of prostate

Question 41

What should you consider in any patient presenting with voiding difficulty, particularly those with incontinence

Answer 41

Detrusor failure or underactive detrusor function. Incontinence may be overflow.

Question 42

Incontinence =

Answer 42

A storage symptom. Any involuntary loss of urine

Question 43

2 ways incontinence can be an issue:

Answer 43

- Social | - Hygiene

Question 44

Types of incontinence:

Answer 44

Stress Urge Overflow Mixed

Question 45

Stress incontinence =

Answer 45

Leakage of urine due to extra abdominal pressure (coughing, sneezing, laughing). Usually due to problem with sphincter.

Question 46

Urge incontinence =

Answer 46

Sudden urge and intense need to pass urine. Usually due to bladder spasms

Question 47

Mixed incontinence =

Answer 47

Stress and urge

Question 48

Overflow incontinence =

Answer 48

Due to chronic retention

Question 49

Incontinence is common in:

Answer 49

- Women - Hospital - Nursing homes

Question 50

UI QoL issues

Answer 50

Distress, embarrassment, inconvenience, hygiene, self-esteem falls, fractures, depression, increased likelihood of institutionalisation

Question 51

Risk factors for UI:

Answer 51

- Pregnancy, childbirth - Obesity - Age, menopause - Constipation - Chronic cough, smoking

Question 52

Treatment of stress incontinence:

Answer 52

- Pelvic floow exercises - a-adrenergic agonists - oestrogens - tricyclic antidepressants - surgery

Question 53

Surgical treatments for stress incontinence:

Answer 53

- Elevation or support of bladder neck: TVT, TVT-O, TOT, SIMUS - Enhance urethral resistance: bulking agents (e.g. collagen)

Question 54

TVT =

Answer 54

Tension free vaginal tape

Question 55

TVT-O =

Answer 55

Tension free vaginal tape oburator

Question 56

TOT =

Answer 56

Transobturator tape

Question 57

SIMUS =

Answer 57

Single incision mid urethral tape

Question 58

Treatment of overactive bladder/urge incontinence:

Answer 58

- Behavioural therapy, relaxation - Anticholinergics - Botox - Surgery

Question 59

Anti-cholinergics:

Answer 59

Oxybutynin, tolterodine

Question 60

Surgery for overactive bladder:

Answer 60

Sacral nerve stimulation | PTNS = percutanous posterior tibial nerve stimulation