L8- responding to symptoms of urinary tract disorders

Question 1

management of stress incontinence

Answer 1

• pelvic floor muscle training
• duloxetine ( for women) - selective serotonin and noradrenaline reuptak inhibitor, relaxes detrusor muscle, increases external sphincter actvitity
• topical vaginal oestrogen therapy (post- menopausal women)

Question 2

management of urge incontinence

Answer 2

• pelvic floor muscle training
• reduction of excessive fluid intake
• topical vaginal oestrogen ( females) to reverse atrophy
• M3 muscarinic receptor antagonist ( males) eg solifenacin

Question 3

incontinence pads

Answer 3

hydrophobic layers draw urine from surface to keep skin dry
sanitary pads are cheap but damp so can irritate skin
washable bed pads are good for travelling

Question 4

avoid using _______ when experiencing stress incontinence

Answer 4

tampons

Question 5

general incontinence magagement for women

Answer 5

• reduce caffeine and alcohol intake , reduce weight and avoid foods that irritates the bladder
• pevlvic floor training, avoid lifting, bladder training
• absorbent devices and catheters
• antimuscarinics, intravaginal oestrogens, treat constipation promptly
• surgery eg synthetic mid urethral tape procedure

Question 6

managements of LUTS - men

Answer 6

• tamsulosin ( alpha 1 adrenoceptor blocker) - since prpstate and bladder neck contain alpha 1. This inhibits contraction of prostatic and bladder neck smooth muscle
• increases urine flow rate (2-3ml/s) and reduces other symptoms of obstruction ( urgency, dribbling, incompete emptying)
• doesnt alter prostate size, growth rate or PSA

Question 7

who can recieve tamsulosin hydrochloride

Answer 7

men age 45-75 if symptoms have lasted over 3 months, when no symptoms of infection (blood in urine), no diabetes/heart/liver/kidney disease or hypotension, no previous prostate surgery or plans for cataract surgery

Question 8

cataract surgery and tamsulosin risk

Answer 8

intraoperative floppy iris syndrome

Question 9

5 alpha reductase inhibitor( finasteride, dutasteride)

Answer 9

• used when very enarged prostate with PSA>1.4
• inhibits metabolism of testosterone to dihydrotestosterone ( DHT more potent driver of prostate growth)
• can be used in combination with an alpha blocker

Question 10

ARIs reduce size of prostate by (%)

Answer 10

25%

Question 11

management of cystitis

Answer 11

drink lots of fluids, avoid delays and empty the bladder fullly , wash area with water and unperfumed soap, paracetamol for mild pain, use of alkalising agents to reduce burning ( avoid in pregnancy and hypertension or renal disease), Antibacterial agent ( requires confirmation from GP but sometimes can be given under a PGD)