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Urinary system > Urinary incontinence > Flashcards

Urinary incontinence Flashcards

1
Q

Define stress urinary incontinence

A
  • The complaint of involuntary leaking on effort or exertion, or on sneezing or coughing
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2
Q

Define urgency urinary incontinence

A
  • The complaint of involuntary leakage of urine accompanied or immediately proceeded by a feeling of urgency
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3
Q

Define mixed urinary incontinence

A
  • The complaint of involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing
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4
Q

Define overflow incontinence (chronic urinary retention)

A
  • The involuntary release of urine when the bladder becomes overly full - due to a weak bladder muscle or to blockage
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5
Q

Define over active bladder

A
  • A frequent and sudden urge to urinate that may be difficult to control
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6
Q

Outline the prevalence of urinary incontinence/OAB

A
  • The presence of of OAB (wet & dry) is much higher than the prevalence of UUI
  • UI increases with age
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7
Q

What are the O&G risk factors for UI?

A
  • Pregnancy and childbirth
  • Pelvic surgery/DXT
  • Pelvic prolapse
  • History of large babies/difficult deliveries/instrumental deliveries
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8
Q

What are the predisposing risk factors for UI?

A
  • Race
  • Family predisposition
  • Anatomical abnormalities
  • Neurological abnormalities
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9
Q

What are promoting risk factors of UI?

A

-Co-morbidities
- Obesity
- Age
- Increased intra-abdo pressure
- UTI
- Drugs
- Menopause
- Cognitive impairment

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10
Q

What are storage symptoms of the lower urinary tract?

A
  • Increased frequency
  • Urgency
  • Nocturia
  • Incontinence
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11
Q

What are voiding symptoms of the lower urinary tract?

A
  • Slow stream
  • Splitting or spraying
  • Intermittency
  • Hesitancy
  • Straining
  • Terminal dribble
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12
Q

What are post-micturition symptoms of the lower urinary tract?

A
  • Post-micturition dribble
  • Feeling of incomplete emptying
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13
Q

What other factors are important to consider with UI?

A
  • Fluid intake habits, particularly in relation to tea coffee
  • Any symptoms of uterovaginal prolapse and faecal incontinence
  • How long have the problems been going on for
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14
Q

If UI is due to neurological damage, which dermatomes should we examine?

A
  • S2, S3, S4
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15
Q

What would we examine in a patient with UI?

A
  • BMI
  • Abdominal exam to exclude palpable bladder
  • Examination of S2, S3, S4 dermatomes
  • DRE (prostate in males)
  • In females, external genitalia (stress test) and vaginal exam
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16
Q

What are the mandatory investigations for suspected UI?

A
  • Dipstick for UTI, haematuria, proteinuria, glucosuria
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17
Q

What are the basic non-invasive urodynamics investigations done for UI?

A
  • Frequency-volume chart
  • Bladder diary (>3 days)
  • Post-micturition residual volume
  • Optional tests include invasive urodynamics, pad tests, cystoscopy
18
Q

Outline how urodynamic testing works

A
  • Pt voids and is then catheterised
  • Catheter used to measure residual volume
  • Infuse set volume (300-400mls) saline into bladder
  • Pressure probe (placed in uterus or rectum) measures pressure in bladder
  • Need abdominal pressure value (ask pt to cough to obtain value)
  • Intravesical pressure - abdominal pressure = detrusor pressure
19
Q

How does the female pelvic floor affect continence?

A
  • Urethra passes through pelvic floor
  • Reduced tone of pelvic floor reduces function of EUS to stay closed and maintain continence
20
Q

What factors determine how UI is managed?

A
  • Depends which symptoms a patient has
  • The degree to which symptoms bother the patient
  • Management should be individualised and have a systematic approach
21
Q

What are the conservative management suggestions for UI?

A
  • Modify fluid intake
  • Weight loss
  • Stop smoking
  • Decrease caffeine intake (UUI)
  • Avoid constipation
  • Time voiding - fixed schedule
22
Q

What contained incontinence methods can mange UI?

A
  • For patients unsuitable for surgery and who have failed conservative and medical management
  • Indwelling catheter (urethral or suprapubic)
  • Sheath device (condom attached to catheter and bag)
  • Incontinence pads
23
Q

What management is specific to SUI?

A
  • Pelvic floor muscle training
  • Duloxetine (offered as an alternative to surgery but not first-line)
24
Q

How is pelvic floor muscle training carried out?

A
  • 8 contractions 3x/day
  • At least 3 months duration
25
Q

What is duloxetine?

A
  • Combined noradrenaline and serotonin uptake inhibitor
  • Lengthens storage phase (NA)
  • Keeps IUS closed (serotonin)
  • Increased activity in striated sphincter during filling phase
26
Q

What surgery can be done for SUI in females?

A
  • Permanent intention
  • Open retropubic suspension procedures
  • Classical autologous sling procedures
  • Low-tension vaginal tapes
  • Temporary intention e.g. if further pregnancies are planned
  • Intramural bulking agents
27
Q

What surgery can be done for SUI in males?

A
  • Artificial urinary sphincter - gold standard
  • Male sling procedure
28
Q

How does an artificial urinary sphincter work?

A
  • Cuff stimulates action of normal sphincter to circumferentially close urethra
  • Switch is present in scrotum
  • Given to patients with urethral sphincter deficiency (neurological, post DXT/surgery)
29
Q

What is the initial management of UUI?

A
  • Bladder training
30
Q

How does bladder training work?

A
  • Schedule of voiding:
    1. Void every hour during the day
    2. Must not void in between - wait or leak
    3. Intervals increased by 15-30 minutes each week until interval of 2-3 hours is reached
  • At least 6 weeks duration
31
Q

What is the pharmacological management of UUI?

A
  • Anticholinergics that act on muscarinic receptors (M2, M3)
  • Reduces reflex that stimulates detrusor to contract
  • Many brands e.g. Oxybutynin, Solifenacin
  • Beta 3 adrenoceptor agonist called Mirabegron
  • Increases bladder’s capacity to store urine
32
Q

What are the side effects of the anticholinergics used to treat UUI?

A
  • Affect M receptors at other sites
  • M1 - CNS, salivary glands
  • M2 - heart smooth muscle
  • M3 - ocular and intestinal smooth muscle, salivary glands
  • M4 - CNS
  • M5 - CNS, eye
33
Q

How does the botulism toxin treat UUI?

A
  • Treats UUI unresponsive to anticholinergics and B3 adrenoceptor agonists
  • Intravesical injection of botulism toxin
  • Inhibits release of ACh at presynaptic neuromuscular junction causing targeted flaccid paralysis
  • Lasts 3-6 months
34
Q

What surgery can be done to treat UUI?

A
  • Sacral nerve neuromodulation
  • Autoaugmentation
  • Augmentation cytoplasty
  • Urinary diversion
35
Q

What is enuresis in children?

A
  • Involuntary wetting during sleep at least 2x/week in children aged >5 years with no CNS defects
36
Q

What is the difference between primary and secondary enuresis?

A
  • Primary = child never achieved sustained continence at night
  • Secondary = stayed dry at night initially (6+ months) but then started bedwetting
37
Q

What key questions would you ask the parent of a child with enuresis?

A
  • Age?
  • Primary or secondary?
  • Do they have daytime symptoms
  • Do they have pain passing urine?
  • How frequently do they pass urine?
  • Are they constipated
38
Q

How is primary enuresis without daytime symptoms treated?

A
  • Usually managed in primary care
  • Reassurance, alarms with positive reward system, desmopressin
39
Q

How is primary enuresis with daytime symptoms treated?

A
  • Usually caused by disorders of lower urinary tract
  • E.g. anatomical, OAB
40
Q

How is secondary enuresis treated?

A
  • Treat underlying cause if it has been identified
  • E.g. UTIs, constipation, diabetes, psychological problems, family problems, physical or neurological problems
  • Primary/secondary care
41
Q

What causes enuresis?

A
  • Children have to wait until they have enough ADH to stay dry overnight

Urinary system (22 decks)

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