Week 8 - Urinary Incontinence Flashcards Preview

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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

What is the detrusor? State its innervation

-Muscular component of the bladder
-Parasympathetic innervation S2-S4