Urinary retention, incontience Flashcards
(31 cards)
What are the 3 types of bladder and urinary disorders?
1) Urinary frequency
2) Enuresis (involuntary urination)
3) Incontinence
What is urinary retention?
Inability to voluntarily urinate. This is a medical emergency.
It is painful and requires immediate treatment by catheterisation
Urinary incontinence definition?
Involuntary leakage of urine and can range in severity and
nature
What is stress incontience?
Involuntary leakage on effort or exertion [e.g. sneezing or
coughing]
Urgency incontinence definition?
involuntary leakage which is accompanied by a sudden compelling desire to pass urine that is difficult to delay
What drugs are used to treat urinary frequency & incontinence?
● Duloxetine - stress incontinence (women only)
Antimuscarinics:
● Oxybutynin
● Tolterodine
● Darifenacin
● Solifenacin
(Antimuscarinics mnemonic: [D.O.T.S])
● Mirabegron (beta-3 adrenoceptor agonist) - prolongs the QT interval
● Antimuscarinics are 1st line and Mirabegron 2nd line
● Propantheline
● TCAs ( Tricyclic antidepressants) e.g. imipramine
How is Urinary frequency and incontinence managed?
By combining drug therapy and non-drug treatment.
Espescially for Duloxetine.
What is the warning for Duloxetine?
Do not withdraw abruptly.
Examples of non-drug treatment for Urinary frequency and incontinence?
Pelvic floor exercises & bladder training
What preparations of Antimuscarinic drugs have less side effects?
Modified-release preps have less side effects
What is nocturnal enuresis?
Involuntary discharge of urine during sleep. Children are usually expected to be dry
by 5 years
What are non-drug treatments for is nocturnal enuresis?
Reassurance, advice on fluid intake, diet, toileting behaviour, reward systems and enuresis alarms [for children who do not respond to previous methods]
What is the drug treatment for nocturnal enuresis?
Oral or sublingual desmopressin.
Imipramine for children who do not respond to all other treatments
What are common side effects of Desmopressin?
Hyponatraemia [too much water dilution] and nausea
Counselling for desmopressin?
Limited fluid intake, from 1 hour before desmopressin dose until 8 hours
afterwards
Hyponatraemic convulsions: Warn patients to avoid fluid overload [including
during swimming] and to stop desmopressin during an episode of vomiting or diarrhoea
which leads to the loss of sodium [until fluid balance is normal/restored]
What is the caution for desmopressin?
Avoid intranasal route due to increased side effects
How is chronic urinary retention treated?
Treated either surgically or medically with alpha blockers [dutasteride & finasteride are alternatives]
What is the common cause of Urinary Retention in men?
BPH - Benign Prostatic Hyperplasia.
Also called an enlarged prostate
What are the complications of BPH?
Renal impairment, Urinary retention OR Recurrent infection
What are the non-drug treatments for urinary retention?
● Catheterisation
● Surgery for men with more severe symptoms that don’t respond to drug therapy or
who have complications e.g. acute urinary retention, renal failure, recurrent UTI
What is the drug treatment for ACUTE & CHRONIC urinary retention?
Alpha blockers (ADMIT):
- Alfuzosin
- Doxazosin
- Tamsulosin
- Indoramin
- Terazosin
- Prazosin (extra)
What are the side effects of Alpha blockers?
Can cause drowsiness and may affect driving and performance of skilled tasks
What is the drug treatment for urinary retention due to BPH?
- Alpha blockers is first line.
- 5 alpha reductase inhibitor, e.g. Finasteride & Dutasteride
This is used for patients with enlarged prostates, raised prostate specific antigen [PSA] concentration and considered to be high risk of progression
What are some cautions for Finasteride and Dutasteride?
- Both excreted in semen, use of condoms is
recommended if sexual partner is pregnant or likely to be pregnant. - Women of childbearing potential should avoid handling crushed
or broken tablets of finasteride or leaking capsules of Dutasteride - Both cause breast cancer [report any breast changes e.g.
lumps, pain or nipple discharge]
