Flashcards in Week 8 - Urinary Incontinence Deck (22):
1
State the innervation of the external urethral sphincter
-Somatic innervation S2-S4 (pudendal nerve)
2
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
3
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
4
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
5
What is urinary incontinence? Name the types
-The complaint of any involuntary leakage of urine
-Stress incontinence
-Urge incontinence
-Mixed incontinence
-Overflow incontinence
6
What is stress incontinence?
-Problems with the external urethral sphincter exacerbated on exertion eg coughing or sneezing
-Common after childbirth
7
What is urge urinary incontinence?
-Involuntary leakage proceeded by urgency
8
What is overactive bladder syndrome?
-Urgency, frequency and nocturia
9
Which is the most common urinary incontinence?
-Stress incontinence
10
Name some obs and gyne risk factors for incontinence?
-Pregnancy and childbirth
-Pelvic prolapse
11
Name some promoting factors of urinary incontinence
-Obesity
-Age
-Menopause
-Cognitive impairment
12
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
13
What general lifestyle interventions can be done to manage urinary incontinece?
-Modify fluid intake
-Weight loss
-Smoking and caffeine
-Timed voiding
-Incontinence pads
14
What types of catheter can be intoduced to manage UI?
-Indwelling catheter
-Sheath catheter
15
What is highly recommended in women to prevent urinary incontinence?
-Pelvic floor exercises
-8 contractions 3x day for at least 3 months
16
Discuss the pharmacological management of stress urinary incontinence
-NA and serotonin uptake inhibitor to increase activity of EUS
17
Discuss the pharmacological management of urge urinary incontinence
-Anticholinergics to block parasympathetic contraction(oxybutynin)
-Boltulinin toxin inhibits Ach release
18
Discuss the pharmacological management of overactive urinary incontinence
-B3-adrenoreceptor agonist to increase bladder capacity to store urine by relaxing detrusor
19
Describe surgical management of stress incontinence for males and females
-Females-> Low-tension vaginal tapes to support urethra, retropubbic suspension
-Males -> artificial urinary sphincter
20
Describe surgical management of urge incontinence
-Sacral nerve neuromodulation
-Urostomy
21
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
22