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Management of incontinence in a 15 year old girl
Mr O’MalleyR CaseyMonday Teaching18/07/05
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Causes
Urge incontinence De novo
Latchkey
Perimenstrual
Giggle Enuresis risoria – Laughter activates micturition
reflex via intermediation of limbic system
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Causes
Ectopic ureter
Infrasphincteric or vaginal Duplex system usually
Usually detected in childhood
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Causes
Stress incontinence
Post partum
+ Wide bladder neck anomaly
Raised intra-abdominal pressures CF, constipation, heavy exercisers
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Causes
Urethrovaginal reflux
Hydrocolpos –BOO or Incontinence
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Causes
Neurological DM DSD ( myelodysplasia/MS)
3-5% children have first MS attack before 16 yo
Spastic paraplegia
Tethered cord syndrome
Complication of spinal dysraphism Tight filum terminale – traction neuropathy Due to abnormal cranial migration of conus
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Causes
UTI’s 5% of girls suffer at least one UTI
40% associated with some underlying urinary tract abnormality
Associated with urge syndrome and detrusor overactivity
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Causes Urethral diverticulum
Acquired usually
Anterior vaginal wall
Distal two thirds urethra where periurethral glands open
Infection of periurethral glands – formation of retention cyst – ruptures into urethra
No muscle in the diverticular sac
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Management
History Dribbling, dysuria, dyspareunia Urgency UTI Retention Provoking factors Marked disturbance of bowel habit
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Physical examination
Palpable bladder Intact hymen
Suburethral mass Palpable urethral stone Expression of purulent material
Hairy patch, cutaneous haemangiomata, sinuses – Spinal dysraphism
Sacral agenesis – flattened buttocks, absence of sacrum
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Physical Examination
Lower limb hyper-reflexia Wasting of calves Deformity of feet
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Investigations MSU/ Blood glucose
Lumbar spine xr Renal U/S
DMSA renogram
Positive pressure retrograde urethrography MR urethra Cystoscopy + EUA
Myelography MR brain/spinal cord Lumbar puncture (OCB’s)
Urodynamics
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Treatment
Anticholinergics Antibiotic treatment +/- suppression
Bladder drill, biofeedback, PFE’s
Laminectomy
Treatment of underlying cause MS, DM, Ectopic ureter
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Treatment Ectopic ureter (infrasphincteric or
vaginal)
Duplex Upper pole nephrectomy Pyelopyelostomy Reimplantation
Single system ectopic ureter
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Treatment
SIC
Bladder augmentation
Intravesical botox