Urinary incontinence and prolapse Flashcards
(25 cards)
What is stress incontinence?
Leakage of urine during raised intraabdominal pressure
What is overactive bladder?
Leakage associated with urgency, usually with detrusor muscle activity
What might cause a fistula leading to incontinence?
Cervical cancer
Obstructive labour
What are the symptoms of voiding difficulty?
Hesitancy
Poor stream
Incomplete emptying
How is urinary incontinence investigated?
History
Examination
Urinalysis
Blood for renal function if suspect renal impairment
Bladder Chart
Pad test
Urodynamics
Others: electromyography, imaging renal tract, cystourethroscopy
What does a bladder chart measure?
Voided volumes
Frequencies
UI episodes
What does a pad test measure?
Quantified urine leakage over time
What is encompassed in urodynamics?
Uroflowometry
Cystometry
What does uroflowometry measure?
Flow rate: enables you to measure peak flow, mean flow and voided volume (minimum of 200mls void is required
What is cystometry?
A method by which the pressure/volume relationship of the bladder is measured during filling, provocation and during voiding
What diagnosis does the urodynamic chart show?
Stress urinary incontinence
What diagnosis does the urodynamic chart show?
Bladder outflow obstruction
What diagnosis does the urodynamic chart show?
Overactive bladder
What are the conservative treatment options for stress incontinence?
Lifestyle: lose weight, stop smoking, reduce caffeinated drinks
Physiotherapy: pelvic floor muscle retraining, biofeedback, electrical stimulation, pessaries
Drugs: duloxetine
Incontinence pads
Vaginal pessaries
What is duloxetine?
A combined noradrenaline and serotonin reuptake inhibitor (increase intraurethral closure pressure)
What are the surgical options for stress incontinence?
Low tension vaginal tape
Intraurethral injection
Artificial sphincters
Colposuspension
What is the low tension tape procedure?
A mesh tape is placed under the urethra like a sling
This keeps the urethra from sagging and keeps it closed when intra-abdominal pressure is raised
What are the conservative treatment options for overactive bladder?
Lifestyle: avoid caffeine
Physiotherapy: bladder training
Drugs: antimuscarinic e.g. oxybutynin
What surgical options are there for treatment of overactive bladder?
Botox injections
Sacral nerve modulation
Augmentation cystoplasty
Bladder overdistension
In uterine prolapse, what are the degrees of uterine descent?
1st degree: in vagina
2nd degree: at interoitus
3rd degree: outside vagina
Procedentia: entirely outside vagina
What types of pelvic organ prolapse are there?
Urethrocele
Cystocele
Rectocele
Enterocele
Uterus and cervix
What is an enterocele?
Pouch of Douglas containing loops of small bowel prolapses into the vagina
What are the symptoms of a cysto/urethrocele?
May be asymptomatic
Stress urinary incontinence
Urinary retention
Recurrent UTI
What are the symptoms of a rectocele?
Dyschezia
Constipation
