Flashcards in Week 8 - Urinary Incontinence Deck (22)
State the innervation of the external urethral sphincter
-Somatic innervation S2-S4 (pudendal nerve)
What type of incontincence is caused by a lower motor lesion of S2-S4? What are the associated symptoms?
-Chronic urinary retention leading to overflow incontinence
-Reduced perianal sensation and lax anal tone
What type of incontinence is caused by upper motor neurone lesion of S2-S4?
-Detrusor Sphincter dyssynergia as there are frequent high pressure detrusor contractions which are poorly coordinated with sphincters
Why do you get hydroureter in detrusor sphincter dyssynergia? What can this lead to?
-Backflow of pressure created by contractions of detrusor causes dilation of ureter and can lead to AKI
What is urinary incontinence? Name the types
-The complaint of any involuntary leakage of urine
What is stress incontinence?
-Problems with the external urethral sphincter exacerbated on exertion eg coughing or sneezing
-Common after childbirth
What is urge urinary incontinence?
-Involuntary leakage proceeded by urgency
What is overactive bladder syndrome?
-Urgency, frequency and nocturia
Which is the most common urinary incontinence?
Name some obs and gyne risk factors for incontinence?
-Pregnancy and childbirth
Name some promoting factors of urinary incontinence
What investigations must be done if urinary incontinence is suspected?
-History to classify type of incontinence
-Abdo examination to exclude palpable bladder
-DRE in males/Stress test/vaginal exam in women
-Urine dipstick is mandatory
-Non-invasive urodynamics eg frequency-volume chart
-Invasive urodynamics eg pressure-flow study
What general lifestyle interventions can be done to manage urinary incontinece?
-Modify fluid intake
-Smoking and caffeine
What types of catheter can be intoduced to manage UI?
What is highly recommended in women to prevent urinary incontinence?
-Pelvic floor exercises
-8 contractions 3x day for at least 3 months
Discuss the pharmacological management of stress urinary incontinence
-NA and serotonin uptake inhibitor to increase activity of EUS
Discuss the pharmacological management of urge urinary incontinence
-Anticholinergics to block parasympathetic contraction(oxybutynin)
-Boltulinin toxin inhibits Ach release
Discuss the pharmacological management of overactive urinary incontinence
-B3-adrenoreceptor agonist to increase bladder capacity to store urine by relaxing detrusor
Describe surgical management of stress incontinence for males and females
-Females-> Low-tension vaginal tapes to support urethra, retropubbic suspension
-Males -> artificial urinary sphincter
Describe surgical management of urge incontinence
-Sacral nerve neuromodulation
Describe the incidence and prevalence of urinary incontinence
-SUI accounts for approximately 50% of incidence followed by mixed then urge the other
-Prevalence increases with age with over 35% having ui over 75