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