TEALE FENNING

Nick Raine-Fenning

Gynaecology 2: March 2008

Discuss the investigations required before starting treatment for wet over-active bladder syndrome (7 marks)

Discuss the NON-pharmacological treatments for over-active bladder syndrome (13 marks)

Xerxes I · Posted: Sun Apr 20, 2008 4:05 pm Post subject:

Discuss the investigations required before starting treatment for wet over-active bladder syndrome (7 marks)

Same dilemma here, does investigation mean investigation only? so no mention of points in history? Ok, let's see

Overactive bladder syndrome is a fairly common problem, specially in older women. althogh it is not a fatal condition, it is associated with significant psychological morbidity is usually detrimental to the quality of life.
A history should elicit any symptoms of urinary tract infection, concommitent stress incontinence, frequency and severity of wet episodes, lifestyle and drinking habbits and any existing medical conditions.

A "frequency-volume chart" to record amount, frequency, timing and type of fluid intake and also to note details of urination and wet episodes is usually a useful tool. It not only involves the patient in the treatment process, but also helps in giving the patient life style change advice that can significantly reduce the need for medical treatment. This chart should be filled in at least for a period of three days.

A midstream unrine sample should be sent for culture and sensitivity to rule out urinary tract infection. If there is clinical suspicioun, culture for atypical organisms (eg mycoplasma, Tuberculosis) should be requested.
If there is any suggestion of bladder malignancy, for example concurrent haematuria, significant family history or toxin exposure, a cystoscopy is warranted.

Multichannel Urodynamic studies is a very useful tool in diagnosis of overactive bladder, however, it is an uncomfrotable and invasive test and is not always necessary. It is reasonable to initiate treatment, specially non pharmocological treatment, without a urodynamic studies result. a significant unprovoked increase in detressor pressure (do we need to know numbers here?, increase in intravesical pressure more than ?15mmh2o)is highly suggestive of the diagnosis of overactive bladder.

Video urodynamics and ambulatory urodynamics are infrequently used.

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 915

Xerxes I · Posted: Sun Jun 08, 2008 7:00 am Post subject:

Thanks Raj

Discuss the NON-pharmacological treatments for over-active bladder syndrome (13 marks)

this should be done with the help of a person experienced in this field, usually a continence nurse specialist, who can build a rapport with the paitent as it can be a long process and needs perseverence.
A change in quantity, frequency and timing of fluid intake may be all is needed to treat mild over-active bladder. The frequency-colume chart can be helpful in advising these changes. It should be noted that too litle drinking along with frequent voiding can actulaly decrease bladder capacity, therefore adequate but not exessive volume intake should be encouraged. cutting down on caffein and alcohol intake can have a significant effect on improvement of symptoms. The patient can help in identifying other foods and drinks that worsen her problems and these should obviously be avoided as much as possible.

Bladder retraining aims at increasing the bladder compliance and capacity and to retrain the neurological pathways and reflexes that cause detressor contractions. the patient is asked to record the time she can hold her urine after feeling the urge. this should be done at home or sometimes in the toilet when she can empty her bladder as soon as needed. She is then asked to increase this time gradually by resisting the urge. this can be very helpful not only by the presumed mechanisms, but also by having the patients full contribution to her own treatment.

Different ways of sacral plexus stimulation have been tried in treating urge and mixed incontinence with varying success. One way is electrode implantation in the sacral roots and using electric durrent to stimulate these roots. Transcutaneous electric stimulation and Electromagnetic stimulation have also been used. These are thought to work through re adjusting low level reflexes and also by strenghening the muscles of the eplvic floor in case of mixed incontinence.

the only non-pharmacological Surgical treatments are surgical reconstruction of the bladder, effectively increasing the bladder capacity by grafting another tissue, usually colon to the bladder. In very rare circumstances, ureteroileostomy can be considered.

last paragraph was probably a bit too much!!
Can't think of anything else

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 915

excellent attempt.

i would have included a small para on the surgical aspects too. do mention the bladder distension and that it's of limited or no use.

r
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SpR O&G Wessex Region

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 915

one could also include the 'Uribag' -- a pocket-sized urinal which will fit into a handbag or the glove box in a car. both male and female versions are available.

this is not a treatment as such but supporting device.
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SpR O&G Wessex Region

Xerxes I · Posted: Sun Jun 08, 2008 7:16 am Post subject:

I'd love one of those. where can you get them?

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 915

where u write about sacral electrode also mention the TENS machiene.

and another thing i'll mention is acupuncture.

with the bladder re-training -- in UK ' body alarms ' are available to help with that.
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SpR O&G Wessex Region

Abik · Posted: Thu Jun 19, 2008 1:24 pm Post subject:

Hi guys
They should call this the walavalkar-xerxes forum!!

Don't know why but I decided to log back in for a nose around.
Can't believe the questions they've asked in the last exam!! Seems to be much harder - or have I just forgotton everything?

Great answers S, where is everyone else?

A
x

Xerxes I · Posted: Sat Jun 21, 2008 1:32 pm Post subject:

Hey Abi, you were badly missed in TF. I will call you later today.

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 915

hi Abi,

good to have u back. how's so'ton been to you? sorry about the 13th, was lwd weekend on call.

r
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SpR O&G Wessex Region

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 915