Pathology
Name the 2 main types of urinary incontinence
Urge incontinence, Stress incontinence
Which type of incontinence occurs when coughing, sneezing or lauging?
Stress incontinence
What test is done to assess for infection, microscopic haematuria and other pathology?
Urine dipstick
What type of movement can help strengthen the pelvic floor muscles?
Pelvic floor exercises (supervised)
What is urge incontinence caused by?
Overactivity of the detrusor muscle of the bladder
Which type of incontinence occurs when there is a sudden need to pass urine with loss of control on the way?
Urge incontinence
For at least how long should a bladder diary be completed for?
3 days
What is the biggest risk with medication such as oxybuynin, tolterodine, solifenacin use in the elderly for urge incontinence?
High ACB: dry mouth, dry eyes, urinary retention, constipations, postural hypotension = inc risk of falls, cognitive decline...
What is stress incontinence?
Name 4 risk factors increasing the risk of developing UI?
increasing age, previous pregnancy/childbirth, high BMI, hysterectomy, postmenopausal status, family Hx, neurological conditions (MS), cognitive impairment/dementia
What is the name of the grading system for assessing the strength of pelvic muscle contractions?
Modified Oxford Grading System
SNRI used as 2nd line where surgery is less preferred in stress incontinence?
Duloxetine
On average, in a healthy adult, how much urine (mL) can the bladder accommodate for?
400 - 600 mL
Give a differential diagnosis for haematuria, persisting bladder, urethral pain, recurruent UTI and constant leakage.
May suggest a fistula (e.g., vesicovaginal)
https://cks.nice.org.uk/topics/incontinence-urinary-in-women/diagnosis/assessment/
What can be measured using a bladder scan to assess for incomplete emptying?
Post-void residual bladder volume
Medication used as an alternative to anticholinergic burden in urge incontinence in the frail elderly?
Mirabegron (beta-3 agonist)
Which receptors on the detrusor muscle predominantly causes bladder contraction during urination & what receptors maintain urethral sphincter contraction during urine storage?
Detrusor: M3 receptors
Urethral sphincter: Alpha-1 adrenergic receptors
What underlying causes and contributing factors must be assed in a comprehensive history? Name/describe 2.
Neurological conditions e.g., PD, Diabetes, cognitive impairment.
History of urinary tract disorders or lower spinal surgery.
Obstetric and gynaecological history, including pregnancies and a history of prolapse or hysterectomy.
The use of medications that can cause or exacerbate incontinence e.g., diuretics.
What can be used to investigate patients with urge incontinence not responding to first-line medical treatments, difficulties urinating, urinary retention, previous surgery or an unclear diagnosis?
Urodynamic Testing
What can be injected into the bladder wall in urge incontinence?
Botulinum toxin type A