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management Incontinence in a 15 year old girl

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This document discusses the management of incontinence in a 15-year-old girl. It outlines various potential causes of incontinence including urge incontinence, ectopic ureter, stress incontinence, neurological issues, urinary tract infections, and urethral diverticulum. The document describes the importance of obtaining a thorough history and physical examination. It recommends investigations such as urine testing, imaging, and urodynamics to evaluate the cause. Potential treatment options discussed include medications, surgery to address specific anatomical issues, and procedures like bladder drill and biofeedback.

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Management of incontinence in a 15 year old girl Mr OMalley R Casey Monday Teaching 18/07/05
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 UTIs 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 (OCBs) Urodynamics
Treatment Anticholinergics Antibiotic treatment +/- suppression Bladder drill, biofeedback, PFEs 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

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management Incontinence in a 15 year old girl

  • 1. Management of incontinence in a 15 year old girl Mr OMalley R Casey Monday Teaching 18/07/05
  • 2. Causes Urge incontinence De novo Latchkey Perimenstrual Giggle Enuresis risoria Laughter activates micturition reflex via intermediation of limbic system
  • 3. Causes Ectopic ureter Infrasphincteric or vaginal Duplex system usually Usually detected in childhood
  • 4. Causes Stress incontinence Post partum + Wide bladder neck anomaly Raised intra-abdominal pressures CF, constipation, heavy exercisers
  • 5. Causes Urethrovaginal reflux Hydrocolpos BOO or Incontinence
  • 6. 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
  • 7. Causes UTIs 5% of girls suffer at least one UTI 40% associated with some underlying urinary tract abnormality Associated with urge syndrome and detrusor overactivity
  • 8. 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
  • 9. Management History Dribbling, dysuria, dyspareunia Urgency UTI Retention Provoking factors Marked disturbance of bowel habit
  • 10. 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
  • 11. Physical Examination Lower limb hyper-reflexia Wasting of calves Deformity of feet
  • 12. 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 (OCBs) Urodynamics
  • 13. Treatment Anticholinergics Antibiotic treatment +/- suppression Bladder drill, biofeedback, PFEs Laminectomy Treatment of underlying cause MS, DM, Ectopic ureter
  • 14. Treatment Ectopic ureter (infrasphincteric or vaginal) Duplex Upper pole nephrectomy Pyelopyelostomy Reimplantation Single system ectopic ureter
  • 15. Treatment SIC Bladder augmentation Intravesical botox