Management ofincontinence in a 15year old girlMr O’MalleyR CaseyMonday Teaching18/07/05
Causes Urge incontinence De novo Latchkey Perimenstrual Giggle Enuresis risoria – Laughter activates micturitionrefl...
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,...
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 T...
Causes UTI’s 5% of girls suffer at least one UTI 40% associated with some underlyingurinary tract abnormality Associat...
Causes Urethral diverticulum Acquired usually Anterior vaginal wall Distal two thirds urethra where periurethral gland...
Management History Dribbling, dysuria, dyspareunia Urgency UTI Retention Provoking factors Marked disturbance of bo...
Physical examination Palpable bladder Intact hymen Suburethral mass Palpable urethral stone Expression of purulent ma...
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...
Treatment Anticholinergics Antibiotic treatment +/- suppression Bladder drill, biofeedback, PFE’s Laminectomy Treatme...
Treatment Ectopic ureter (infrasphincteric orvaginal) Duplex Upper pole nephrectomy Pyelopyelostomy Reimplantation S...
Treatment SIC Bladder augmentation Intravesical botox
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management Incontinence in a 15 year old girl

  1. 1. Management ofincontinence in a 15year old girlMr O’MalleyR CaseyMonday Teaching18/07/05
  2. 2. Causes Urge incontinence De novo Latchkey Perimenstrual Giggle Enuresis risoria – Laughter activates micturitionreflex via intermediation of limbic system
  3. 3. Causes Ectopic ureter Infrasphincteric or vaginal Duplex system usually Usually detected in childhood
  4. 4. Causes Stress incontinence Post partum + Wide bladder neck anomaly Raised intra-abdominal pressures CF, constipation, heavy exercisers
  5. 5. Causes Urethrovaginal reflux Hydrocolpos –BOO or Incontinence
  6. 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. 7. Causes UTI’s 5% of girls suffer at least one UTI 40% associated with some underlyingurinary tract abnormality Associated with urge syndrome anddetrusor overactivity
  8. 8. Causes Urethral diverticulum Acquired usually Anterior vaginal wall Distal two thirds urethra where periurethral glandsopen Infection of periurethral glands – formation ofretention cyst – ruptures into urethra No muscle in the diverticular sac
  9. 9. Management History Dribbling, dysuria, dyspareunia Urgency UTI Retention Provoking factors Marked disturbance of bowel habit
  10. 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 ofsacrum
  11. 11. Physical Examination Lower limb hyper-reflexia Wasting of calves Deformity of feet
  12. 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 (OCB’s) Urodynamics
  13. 13. Treatment Anticholinergics Antibiotic treatment +/- suppression Bladder drill, biofeedback, PFE’s Laminectomy Treatment of underlying cause MS, DM, Ectopic ureter
  14. 14. Treatment Ectopic ureter (infrasphincteric orvaginal) Duplex Upper pole nephrectomy Pyelopyelostomy Reimplantation Single system ectopic ureter
  15. 15. Treatment SIC Bladder augmentation Intravesical botox

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