management incontinence in a 15 year old girl
TRANSCRIPT
Management of incontinence in a 15 year old girl
Mr O’MalleyR CaseyMonday Teaching18/07/05
Causes
Urge incontinence De novo
Latchkey
Perimenstrual
Giggle Enuresis risoria – Laughter activates micturition
reflex via intermediation of limbic system
Causes
Ectopic ureter
Infrasphincteric or vaginal Duplex system usually
Usually detected in childhood
Causes
Stress incontinence
Post partum
+ Wide bladder neck anomaly
Raised intra-abdominal pressures CF, constipation, heavy exercisers
Causes
Urethrovaginal reflux
Hydrocolpos –BOO or Incontinence
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
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
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
Management
History Dribbling, dysuria, dyspareunia Urgency UTI Retention Provoking factors Marked disturbance of bowel habit
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
Physical Examination
Lower limb hyper-reflexia Wasting of calves Deformity of feet
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
Treatment
Anticholinergics Antibiotic treatment +/- suppression
Bladder drill, biofeedback, PFE’s
Laminectomy
Treatment of underlying cause MS, DM, Ectopic ureter
Treatment Ectopic ureter (infrasphincteric or
vaginal)
Duplex Upper pole nephrectomy Pyelopyelostomy Reimplantation
Single system ectopic ureter
Treatment
SIC
Bladder augmentation
Intravesical botox