Urinary incontinence

Question 1

Types of unrinary incontincence

Answer 1

Stress urinary incontinence

Urge incontinence

others : high pressure chornic retention, post-micturition dribble, contant leaking

Question 2

Stress urinary incontinence

Answer 2

• as a result of hypermobility, and neuromuscular problems that causes weak internal sphincter, wehn abdominal pressure increases anf the stability of the urethra decreased

Question 3

Urge incontinence

Answer 3

leakade accompanied or immediately preceded by urgency

overactive bladder /detrussre instability or due to a pathology

Question 4

High pressure chronic retention

Answer 4

on sleeping the pressure in the baldder overtakes the sphincter continence and bed wetting

Question 5

Post-micturition dribble

Answer 5

prostate enlarges, sits in the bulbar urethra and comes out

Question 6

Constant leak of urine

Answer 6

Fistula - in women with pelvic surgery/ bladder damage during hysterectomy

Question 7

Little girl always dribbling the whole time

Answer 7

ectopic ureter –> opens into the proximal urethra or vagina –> needs surgery to re-implant it

Question 8

Micturition cycle problems from the brain

Answer 8

Thalamus, scaral micturition centre, diabetic damage to periphersl nerves, cerebral lesions, micturition centre in the forntal lobe,

bladder - hypotonic (high pressure bladder developed and the bladder contracts repeatedly and empties constantly)

Question 9

Who is it more common in?

Answer 9

Women –> Causcasian > Afro-carribeans

Question 10

Bladder extrophy

Answer 10

front of the pelvis doesnt close properly and the bladder is open on the surface

Question 11

Risk factors

Answer 11

fistula, ectopic ureter in girls, urehtral diverticulum, urethral fistula, surgeries, child birth

Question 12

Risk factors

Answer 12

smokin - causing cough
obesity
infection - UTO
poor nutrition
ageing
cognitive defect
poor mobility
oestrogen deficiency

Question 13

History in urinary incontincence

Answer 13

Type 
Triggering factors
frequency
defree of bother
risk factors
sense of something coming down (prolapse)
Red flags:
painful micturition, haematuria, recurrent UTI, significant vioding

Question 14

Physical exam women

Answer 14

Chaperone
lie down

as them to cough, look for bladder dripping, examine abdomen for palpable bladder, pelvic exam to asses floor muscle strength, bladder neck mobility, vulva for oestrogen deficiency in older women

Question 15

Physical exam both sexes

Answer 15

abdomen fro palpable bladder

Question 16

Basic investigation

Answer 16

Bladder diary - frequency, timing and how much they drink
urinalysis - +/_ culture
flow rate and post-void residue
pad testing

normal void - men 25/30 mls per sec
(bell shaped curved)

women - faster as the urethra is shorter

Renal function
Blood tests
imaging
cystoscopy

Question 17

Cystometry

Answer 17

overactive bladder or for surgeries

2-way catheter - one for water and the other for pressure (detrssur pressure)

rectum - to remove the artefact (subtracts abdominal pressure)

ask them when they feel the urge to void and stuff

Question 18

Cystometry actiity

Answer 18

no detrusser activity on filling

overactive bladder- reaches 200 mls and they can’t hold on and have to pee

Question 19

What is the conservative treatment?

Answer 19

pelvic floor exercises - pelvic floor exercises, needs to be practiced all the time to maintain the benefit

lifestyle modification- weight loss, stop smoking, modify fluid intake

biofeedback - instrument that gives you a visual/ auditory feedback as to which mucle you should strengthen and train

muscle - duloxetine - increase sphincter activiyt, but doesnt work that much

Electrical stimulation of the pelvic flood - not that helpful

Question 20

Surgical treatment

Answer 20

inject bulking materials submucosally - > to increase resistnace, in women esp in stress incontinence, silicon or teflon pastes

Question 21

contraindications for surgery

Answer 21

UTI, untreater bladder overactivitiy (dont want to increase their outflow resistance), bladder neck stenosis

Question 22

What is retropubic suspension?

Answer 22

to treat -female stress oncontinence, hypermobile urethra

lift and fix to-a retro0urethral position

Bursch col- suture vagina on either side of the urethra and attach it to the lateral pelvic wall - suspend the bladder neck and urethra
succes rate - 70%

Question 23

Suburethral tapes and slings

Answer 23

recent
pelvic pain associated
complications
insicionin the vagine, anterior under the urethra to push up either end of the bladder and attach it to the lower end of the abdominal wall and tight it

support the urethra for those with intrisic sphincter deficiency

Question 24

pubovaginal sling

Answer 24

wih rectal fascia

Question 25

Artificial urinary sphincter

Answer 25

implant more in men balloon, pump and cuff ballon in the iliac fossa, cuff around urethra, pump in scrotum, when full man pumps, moves the the fluid to balloon and deflateds the cuff. the cuff automatically refills in 3min can get urethral atrophy and stuff

Question 26

Overactive ballder

Answer 26

urgency and mostly with urge incontinence usually with frequency and nocturia

Question 27

management for overactive bladder

Answer 27

Pelvic floor exercises behaviour modification --> cut out caffeine and alcohol modify fluid intake - try to hold on or 5 min, then 10 min --> densensitise bladder over the course of the time acupuncture and electrical stimulation

Question 28

anticholinergic medication (antimuscarinin)

Answer 28

helps to contol the derusser side effects - dry mouth, GORD, constipation, cognitive impairement, anti-cholinergic burden in the elderly immediate release oxybutynin - not that good so try to reduce the frequency of using it

Question 29

Contra-indication for anti-cholinergics

Answer 29

anrrow angles galucoma, myasthenia gravis, UC

Question 30

B-aginists

Answer 30

helps increase bladder capacity without changing bthe pressure or volume contraindication - uncontrolled hypertension

Question 31

Intravesical botulinium toxin

Answer 31

botox paralyses the detrusser muscle and stops the over activity but they might not be able to void for 2-3 weeks so they need to be ready to self-catheterise, and do this 2-3 times per year

Question 32

neuromodulation

Answer 32

sacral nerve stimulation involved electrical stimulation of the baldder's nerve supply to suppress reflexes responsible for involuntary detrusser contraction external device that can stimulate the S3 afferent nerve at the level of the sacral spinal cord

Question 33

Clam ileocystoplasty

Answer 33

intractable incontinence, and have tried everything else, change in bowel habit, urge and UUI in patients patient has an operation to bivalve the bladde to make it into 2 flaps, thus it destroys the bladders ability to contract and squeeze down with as much pressure as before take the mesentery of SI, flap of mesentery with blood supply and suture it on the bladder complications - mucus in bladder

Question 34

Ileal conduit urinary diversion

Answer 34

last resort, those who have hadradiotherapy to the pelvic instead of indwelling catheter ureter disconnected, ureter then sutured to the ileum and then to a stoma and outside