Urinary Incontinence Flashcards Preview

Y3M - Urology > Urinary Incontinence > Flashcards

Flashcards in Urinary Incontinence Deck (19)
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1

Subtypes of urinary incontinence

Stress

Urge

Mixed

Overflow

Continuous

2

Pathophysiology of stress

Urine leakage occurring when intra-abdominal pressure exceeds the urethral pressure.

Exacerbated by coughing, straining, laughing or lifting.

It is mainly due to weakness of the pelvic floor muscle

3

Risk factors of stress UI

Post-partum due to damage of pelvic floor muscles and weakening of the urethral sphincter.

Constipation

Obesity

Post-menopausal

Pelvic surgery like TURP

4

Pathophysiology of Urge UI

Overactive bladder by detrusor hyperactivity.

This leads to uninhibited bladder contractions and a rise in intravesical pressure -> leakage of urine.

5

What might urge UI be due to.

Neurogenic causes like previous stroke, parkinsons or MS

Infection

Malignancy

Medication like cholinesterase inhibitors can also cause it.

6

Pathophysilogy of overflow UI

Normally a complicaiton of chronic urinary retention.

There is stretching of the bladder wall which leads to damage of the efferent fibres of the sacral reflex and a loss of baldder sensation.

When the bladder fills, it becomes grossly distended and then constant dribbling occurs.

7

Causes of overflow UI

Most common = Prostatic hyperplasia

Can also be due to spinal cord injury or congenital defects

8

What is continuous UI

Constant leakage of urine.

Usually an anatomical abnormality like ectopic ureter, bladder fistulae like vesicovaginal fistula.

9

Clinical features

Need to make sure to categorise it to the correct one.

There might be dysuria or haematuria

Ask about any precipitating factors, past medical and surgical history and drug history.

10

What should be done in order to keep record of urinary habits?

Bladder diaries

QoL questionnaires liike ICIQ, BFLUTS and I-QOL can quantify the severity of the condition.

11

Examination

Check for enlarged prostate

Prolapse

Fistula opening

12

Initial investigations

Midstream urine dipstick

Post-void bladder scans especially in overflow UI.

13

Further investigations

If unclear aetiology urodynamic assessment can be useful.

Intravesicular and intra-abdominal pressures are measured.

This allow for the detrusor muscle pressure to be calculated and any hyperactivity can then be seen.

Outflow urodynamics can also be done to measure detrusor muscel activity.

Cystoscopy, intravenous urogram, vaginal speculum examination or MRI imaging might also be done.

14

Lifestyle advice

Weight loss

Reducing caffeine intake

Avoid drinking either excessive fluids or alcohol

Smoking cessation

15

Conservative management of stress UI or mixed UI

Pelvic floor muscle training ideally for at least 3 months

If no response to PFMT -> duloxetine (Serotonin-norepinephrine reuptake inhibitor) can be trialled to cause stronger urethral contractions.

16

Conservative managemnt of Urge UI

Anti-muscarininc durgs like oxybutynin or tolterodine acting to inhibit the detrusor contraction.

Bladder training should also be offered at least for 6 weeks

17

Indications for surgical management

Symptoms despite consertvatie management

18

Surgical interventions in urge UI

Botulinum toxin A injections

Percutaenous sacral nerve stimulation

Augmentation cystoplasty

Urinary diversion via ileal conduit

19

Surgical interventions for stress UI

Tension-free vaginal tape

Oen colposuspension elevating the bladder neck and urethra through a lower abdo incision

Intramural bulking agents

Artifical urinary sphincter