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Flashcards in Urinary Incontinence Deck (38)
1

Frequency, small voided volumes
Urgency
Provocation
Key in the door
Sound of running water
Standing up
Coughing, laughing
Enuresis

Urge Urinary Incontinence

2

Volume of urine produced in urge incontinence?

What may provoke the urge?

Small volume produced very frequently

Provocation: key in the door, sound of running water, standing up, coughing, laughing

Enuresis (wetting the bed at night)

3

Treatment for urge incontinence

Dietary discretion (avoid caffeine)
Biofeedback
Bladder retraining, Time bladder emptying
Pharmacotherapy
Antimuscarinics - (e.g. oxybutynin, tolterodine)
Beta 3 adrenergics (mirabegron)
Botulinum toxin injection – unlicenced
Neuromodulation (“pacemaker” for the bladder)
Surgery
Enterocystoplasty

4

What is urinary incontinence?

The complaint of any involuntary leakage of urine

5

Name 2 ways in which urine may leak by an extraurethral route?

Extopic ureter
Fistula

6

Which pressure is responsible for the voiding phase?

Detrusor pressure

7

Where is the spinal bladder centre?

S2-S3

8

Bladder outflow obstruction

Huge palpable bladder

Chronic retention

Insensible incontinence

Often wet at night

Renal impairment

Overflow incontinence

9

Overflow incontinence

Bladder outflow obstruction

Huge palpable bladder

Chronic retention

Insensible incontinence

Often wet at night

Renal impairment

10

Which type of drug may precipitate urge incontinence?

Diuretics

11

How would you diagnose detrusor overactivity?

Urodynamics

12

What is detrusor overactivity?

Bladder dysfunction characterised by detrusor contractions occurring during inhibition of voiding

13

Causes of detrusor overactivity

Afferent overstimulation (e.g. due to irritation in the bladder)

Excess central facilitation

Paraplegia

Destruction of S2-S3 centre

Pelvic surgery/fracture (parasympathetic nerves damaged)

Idiopathic detrusor overactivity

14

What is (urodynamic) stress incontinence

Urine leaks during increased intra abdominal pressure, without a detrusor contraction

15

Detrusor contraction in (urodynamic) stress incontinence?

No

16

What causes (urodynamic) stress incontinence?

Damage to the pelvic floor or urethral function
e.g. child birth

17

How to diagnose (urodynamic) stress incontinence?

Urodynamics

18

There is someone with a distended tummy, how do you know its the bladder?

Painless palpable mass arising from the pelvis
Cannot "get below it"
Dull to percussion

19

Treatment for overflow incontinence

Assess renal function
Treat the obstruction
Catheterise
rehabilitate the bladder
Teach intermittent self catheterisation

20

Treatment for urge urinary incontinence

Dietary discretion (avoid caffeine)
Biofeedback
Bladder retraining, Time bladder emptying
Pharmacotherapy
Antimuscarinics - (e.g. oxybutynin, tolterodine)
Beta 3 adrenergics (mirabegron)
Botulinum toxin injection – (was unlisenced, one now liscenced)
Neuromodulation (“pacemaker” for the bladder)
Surgery
Enterocystoplasty

21

Antimuscarinics you could use in urge urinary incontinence?

Oxybutynin
Tolterodine

22

What are oxybutynin and tolterodine?

Anti-muscarinics

23

Name a beta 3 adrenergic you could use in urge urinary incontinence?

Mirabegron

24

What is mirabegron?

A beta-3 adrenergic (you coud use this in urge urinary incontinence)

25

Surgery you might carry out in urge incontinence (very last choice)

Enterocystoplasty (allows the bladder to hold more urine)

26

What is duloxetine?

Serotonin 5-HT

27

Treatment for stress incontinece

Weight loss
Stop smoking!
Pelvic floor exercises - physiotherapy
Pharmacotherapy – (not very much role)

Duloxetine (serotonin (5-HT) and norepinephrine (NE) reuptake inhibitor)
Surgical correction
Open procedures – colposuspension
largely replaced by:
Minimally invasive “tape” procedures

28

What is colposuspension?

Putting stitches in to support the neck of the bladder

-very last surgery option for stress incontinence (now been replaced by "tape" procedures)

29

Which non-urethral cause of urinary incontinence should you be aware of in developing countries?

Vesico-vaginal fistula

-this is because they have prolonged obstructed labour

30

Voiding symptoms

Slow stream
Splitting/spraying of the urinary stream
Hesitancy
Straining

31

What does a frequency volume chart record?

Records the volumes voided as well as the time of micturition, day and night for at least 24 hours

32

What is urinary incontinence?

Urinary incontinence is the complaint of any involuntary leakage of urine.

33

What is stress urinary incontinence?

Stress urinary incontinence is involuntary leakage on effort or exertion, or on sneezing or coughing.

34

What is urgency urinary incontinence?

Urgency urinary incontinence is involuntary leakage accompanied by, or immediately preceded by urgency

35

What is urgency?

Urgency is the complaint of a sudden compelling desire to pass urine, which is difficult to defer

36

What is over active bladder syndrome/urge syndrome/urgency-frequency syndrome?

Urgency, with or without urge incontinence, usually with frequency and nocturia, can be described as overactive bladder syndrome, urge syndrome or urgency-frequency syndrome

37

What is detrusor overactivity incontinence?

Detrusor overactivity incontinence is incontinence due to an involuntary detrusor contraction

38

What is mixed urinary incontinence?

Mixed urinary incontinence is involuntary leakage associated with urgency and also with exertion- effort, sneezing or coughing.