INCONTINENCE AND OTHER UROLOGICAL DILEMMAS DR. ANNA LAWRENCE UROLOGIST AUCKLAND HOSPITAL 161 UROLOGY

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1 INCONTINENCE AND OTHER UROLOGICAL DILEMMAS DR. ANNA LAWRENCE UROLOGIST AUCKLAND HOSPITAL 161 UROLOGY

2 COVERING INCONTINENCE BE ON JUST NAPPIES CATHETERS TYPES AVAILABLE AND WHEN TO USE THEM JJ STENTS??? WHAT ARE THESE THINGS AND WHY IS THE PATIENT SUFFERING SO MUCH

3 INCONTINENCE Is the complaint of any involuntary leakage of urine Approximately 24 to 35% of New Zealanders suffer Urinary Incontinence Estimated 8 billion dollars a year

4 INCONTINENCE It is not a normal part of a woman's aging process to develop uncomfortable, troublesome symptoms of incontinence or prolapse. Women need not learn to live with it. American Urogynaecology Society

5 COMPLICATIONS OF URINARY INCONTINENCE FALLS AND FRACTURES: Urge incontinence independently INCREASES FALLS by 26% INCREASES FRACTURES by 34%

6 TYPES OF INCONTINENCE URGE STRESS OVERFLOW CONTINUOUS

7 CONVERSATIVE MEASURES REVIEW FLUID INTAKE TOO MUCH TOO LITTLE BLADDER DIARY EASY WAY TO REVIEW THIS

8 CONVERSATIVE MEASURES REVIEW PHYSICAL BARRIERS HOW FAR TO THE TOILET HOW EASY DO THEY MOVE STICKS / WALKERS CLOTHING- TOO MANY BUTTONS/ ZIPPERS

9 NEW IN MANAGEMENT OF INCONTINENCE: URGE Long term anti-cholinergic use increases / causes cognitive decline BOTOX TIBIAL NERVE STIMULATION SACRAL NERVE MODULATION

10 NEW IN MANAGEMENT OF INCONTINENCE: STRESS Grave concern regarding Mesh use in Stress Incontinence: FDA warnings refer to transvaginally placed mesh for prolapse repair surgeries Transvaginal midurethral slings are still considered safe in TRAINED HANDS

11 NEW IN MANAGEMENT OF INCONTINENCE: OVERFLOW Overflow represents a bladder that is unable to empty due to 1. bladder failure / hypotonic or atonic detrusor 2. obstruction of emptying with resultant overflow Often symptomatically difficult to dx USS with Post void residual is helpful Vaginal examination to ensure no pelvic masses

12 CATHETERS Female SHOULD NOT be left with long term indwelling URETHRAL catheters due to the real risk of Urethral EROSION Intermittent catheterisation Supra-pubic catheter

13 CATHETERS Multiple companies with multiple options Only limit to choice is affordability

14 CATHETERS Types available Silver coated Curved Hydrophilic Silicon Latex free Short

15 CATHETERS CARES... URETHRAL: NOT appropriate long term for Females due to the risk of urethral erosion SUPRA PUBIC: Important to alternate the leg the bag is place on to prevent a lopsided track

16 CATHETERS CARES... PLEASE DO NOT TAPE THE BAG DOWN

17 CATHETERS CARES... IMPORTANT NOT TO PUT CATHETERS ON TENSION AS CAUSES EROSION OF MEATUS AND SKIN

18 CATHETERS INTERMITTENT: USE IN THE PLACE OF LONG TERM INDWELLING CATHETERS FOR BOTH MALE AND FEMALE PATIENTS PLACED EVERY FOUR HOURS ALLOWS MORE FREEDOM

19 INFECTIONS WITH CATHETERS IN PLACE 1. Urine samples must NOT be taken from the bag 2. Bacteria that has colonised the catheter and catheter bag should NOT be treated with Antibiotics 3. Catheter should be changed if infection present

20 CONTINENCE SERVICES EACH DHB HAS A CONTINENCE SERVICE: HOW MANY NAPPIES/ PADS A DAY VARIES BETWEEN EACH DHB ALSO SUPPLY CONDOM STYLE CATHETERS ADDITIONAL HELP FOR CHEAP PRODUCTS

21 JJ STENTS

22 JJ STENTS Hollow tube with multiple small holes / perforations allowing the passage of urine from the kidney to the bladder

23 JJ STENTS NORMALLY PLACED FOR KIDNEY OBSTRUCTION OR POST STONE SURGERY

24 JJ STENTS PROBLEMS PROBLEMS PROBLEMS BLADDER IRRITATION FREQUENCY URGENCY URGE INCONTINENCE URINE WILL LOOK LIKE AN INFECTION-RBC AND WBC PRESENT BUT NO ACTUAL GROWTH TREAT THE DISCOMFORT BUT NO AB UNLESS GROWTH ON MSU

25 JJ STENTS PROBLEMS PROBLEMS PROBLEMS Reflux pain: holds open the ureteric orfice so when voiding experience reflux pain associated with urine going back up to the kidney

26 THANK YOU QUESTIONS??

27

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