Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
20 Cards in this Set
- Front
- Back
|
What is stress incontinence
|
the involuntary leakage of urine with exertion, or on coughing or sneezing
|
|
|
What is urge incontinence
|
the involuntary leakage of urine accompanied by or immediately preceded by urgency
|
|
|
Which incontinence is the most common?
|
stress
|
|
|
What are the obstetric RF for incontinence
|
> 4000g
3rd degree tear Forceps Length (second stage) |
|
|
What specific examinations can be done to test incontinence
|
stress provocation test = patient is asked to cough vigourously while the doctor observes for incontinence of urine.
IF the bladder is empty, the test will be negative. NB: a negative test does not rule out stress incontinence. Low sensitivity, high specificity Bonney's test and Q tip test - Waste of time. 1, 2, or 24 hr Pad test - get patient to walk up stairs, jog/hop etc and weight pad - cannot differentiate stress and urge |
|
|
What investigations can be done for incontinence
|
US - used if acute incontinence, mass noted, symptomatic voiding dysfunction, recent UTI (+ renal US), pain
Urodynamics Cystoscopy - if bad bladder pain, persistent haematuria, past history TCC, recurrent UTI |
|
|
What are urodynamics
|
Set of tests that measures function f the urinary tract by measuring various aspects of urine storage and evacuation
Cystometry - evalutes bladder function by measuring pressure and volume of fluid in the bladder during filling, storage and voiding Uroflowmetry - measures the rate of urine flow Urethral pressure profile tests urethral function Leak point pressure measures the bladder or abdominal pressure when leakage occurs |
|
|
Treatment of stress incontinence
|
Pelvic floor mm exercises
Mid urethral slings Intravaginal devices - support and partially compress the urethra (tampon, tampon like devices, continence rings, pessaries) Operations - laparoscopic and open coposuspension, artificial sphincter |
|
|
Treatment of urge incontinence (overactive bladder)
|
Bladder retraining - distraction techniques
Pharmacology - antimuscarinics/anticholintergics e.g., propanthene, oxybutinin (ditropan, Solifenacin (vesicare) TCAs (Tofranil (night)) |
|
|
Why are anticholinergics/antimuscarinics used to treat overactive bladder
|
Acetylcholine binds with muscarinic receptors to make the detrusor mm contract
Those drugs block the M3 muscarinic receptors to stop acetylcholine binding therefore inhibiting contraction of the detrusor mm |
|
|
How effective are anticholinergics/antimuscarinics at treating urge incontinence
|
Suboptimal
after 3 months 50% stopped therapy After 6 months - 80% stopped therapy They mostly stop due to lack of efficacy |
|
|
Pathophysiology of stress incontinence
|
Weakness at the urethral sphincter so that the sphincter cannot prevent urine flow in the presence of higher abdominal pressure, such as when coughing
|
|
|
Risk factors for stress incontinence
|
Pelvic prolapse
pelvic surgery vaginal delivery hypoestrogenic state age smoking neurologica/pulmonary disease |
|
|
Risk factors for urge incontinence
|
Bladder cancer
Bladder inflammation Bladder outlet obstruction Bladder stones Infection MS Spinal cord injury |
|
|
Which nerve roots contribute to sympathetic control of the urethra?
|
Via the hypogastric nerve
T10-L2 |
|
|
Which nerve roots contribute to PNS control of the detrusor mm?
|
Pelvic nerve
S2-S4 |
|
|
What is herniation of the bladder into the vaginal lumen called
Urethra? Rectum? Intestines? |
Bladder herniation = Cystocele
Urethra herniation = urethrocele Rectum = rectocele Intestines = enterocele |
|
|
RF for uterine prolapse
|
vaginal childbirth
age decreased oestrogen increased intra-abdominal pressure (obesity, chronic cough, constipation, ascites) congenital (rarely) collagen disorders |
|
|
Symptoms of uterine prolapse
|
Groin/back pain
feeling of heaviness/pressure in the pelvis (worse with standing, lifting, worse at the end of the day, relieved by lying down) +/- urinary incontinence |
|
|
Treatment of uterine prolapse
|
Can try conservative - hormonal therapies to restore lost support and tone (oestrogen), pelvic floor exercises, mechanical support devices (pessaries)
Surgical repair: Reconstructive surgery - corrects prolapsed vagina OR Total vaginal hysterectomy +/- surgical prevention of vault prolapse |
