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WCS > 10. Urinary Dysfunction 1 Surgery, urologic testing, OAB, Retention, Nocturia, Incontinence, Outcome Measures > Flashcards

10. Urinary Dysfunction 1 Surgery, urologic testing, OAB, Retention, Nocturia, Incontinence, Outcome Measures Flashcards

1
Q

What is pelvic floor muscle training (PFMT)?

A

First-line conservative treatment for stress urinary incontinence in women

PFMT is designed to strengthen pelvic floor muscles to help control urinary leakage.

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2
Q

What are examples of active treatments for urinary incontinence?

A
  • Physical therapies (e.g. vaginal cones)
  • Behavioural therapies (e.g. bladder training)
  • Electrical or magnetic stimulation
  • Mechanical devices (e.g. continence pessaries)
  • Drug therapies (e.g. anticholinergics, duloxetine)
  • Surgical interventions

Active treatments aim to manage urinary incontinence through various methods.

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3
Q

What was a key finding regarding PFMT combined with electrical stimulation?

A

More women reported cure or improvement of SUI with PFMT + e-stimulation compared to e-stimulation alone, but not statistically significant

This indicates some potential benefit, but the lack of statistical significance suggests caution in interpretation.

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4
Q

What was concluded about the addition of PFMT to drug therapy?

A

Only one trial evaluated PFMT with drug therapy, providing very low evidence about adverse events

This highlights the need for more research in this area.

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5
Q

Following the study of PFMT for SUI combined with other treatments, what were the main outcomes?

A

insufficient evidence to say if there are benefits of adding PFMT to other active treatments when compared with the same treatment alone for urinary incontinence (SUI, UUI or MUI) in women. this included: heat via sheet, vaginal cone, drug therapy, and bladder diary

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6
Q

What is stress urinary incontinence (SUI)?

A

Complaint of involuntary leakage of urine with coughing, sneezing or physical exertion

SUI is the most common type of incontinence, particularly prevalent in young and middle-aged women.

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7
Q

What are common risk factors for SUI?

A
  • Pregnancy
  • Vaginal delivery
  • Increasing parity
  • Advancing age
  • Post-menopausal state
  • Obesity

These factors contribute to weakening pelvic floor support and bladder control.

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8
Q

Define urgency urinary incontinence (UUI).

A

Involuntary leakage of urine associated with urgency without UTI or pathology

UUI is more common in older women and may significantly impact quality of life.

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9
Q

What is the difference beteen Urodynamic stress incontinence (USI)
and Urgency urinnary incontince UI

A

Urodynamic stress incontinence (USI)
involuntary leakage of urine with increased intra-abdominal pressure in the absence of detrusor contraction during urodynamic evaluation

Urgency urinary incontinence (UUI)
involuntary leakage of urine associated with urgency without UTI or pathology

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10
Q

Surgical interventions for SUI include

A

sling procedures
colposuspension
injection of periurethral bulking agents

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11
Q

Drug therapies for SUI include

A

Drug therapies include
anticholinergics
duloxetine
local vaginal oestrogens
intravesical botulinum toxin

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12
Q

which population is SUI most common in?

A

prevalent in young and middle-aged women, particularly those who are white and non-Hispanic

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13
Q

What characterizes overactive bladder (OAB)?

A

Presence of urinary urgency with frequency and nocturia

OAB can be classified as OAB-wet (with UUI) or OAB-dry (without UUI).

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14
Q

What does mixed urinary incontinence (MUI) entail?

A

Involuntary leakage of urine associated with urgency, exertion, sneezing, and coughing

MUI involves symptoms of both SUI and UUI.

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15
Q

How does PFMT purportedly work?

A
  • Patients learn conscious pelvic floor muscle precontraction
  • Increases muscle volume for structural support
  • Provides mechanical increase in intra-urethral pressure
  • Raises position of the levator ani muscle
  • provide more support to the bladder neck and proximal urethra
  • conscious pelvic floor muscle precontraction before and during exertion to prevent urine leakage (co-ordination)

These mechanisms together help prevent urine leakage during exertion.

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16
Q

What were the findings regarding PFMT + bladder training?

A

Women receiving combined PFMT and bladder training were more likely to be cured than those with bladder training alone, but this difference was not statistically significant

The combination showed potential but lacked strong evidence.

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17
Q

What is the significance of the heat and steam generating sheet (HSGS)?

A

Hypothesized to reduce incontinent episodes by heating the abdominal and lower back, resulting in positive effects on renal function

The combination of PFMT and HSGS showed statistically significant improvement compared to HSGS alone. Combo of meds and PFMT was stat sig too, but not specified which

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18
Q

True or False: The review concluded that there is strong evidence for the benefits of adding PFMT to other active treatments.

A

False

The review indicated insufficient evidence to support the addition of PFMT to other treatments.

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19
Q

detrusor overactivity (DO)

A

spontaneous or induced detrusor contraction is observed during urodynamic testing

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20
Q

reflex inhibition of detrusor

A
  • In continent individuals
    reflex (involuntary) contraction of the pelvic floor muscles and striated muscle of urethra happen during filling (storage) phase of the bladder
    This leads to increased intra-urethral pressure and reflex inhibition of detrusor contraction, thereby preventing urine leakage and urgency
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21
Q

What is maintained during normal urine storage?

A

Continence is maintained with normal urethral closure and urethral support

Urethral support is provided by endopelvic fascia, arcus tendineus fascia pelvis (ATFP), and levator ani muscles.

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22
Q

What structures provide urethral support?

A
  • Endopelvic fascia of the anterior vaginal wall
  • Arcus tendineus fascia pelvis (ATFP)
  • Medial portion of the levator ani muscles
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23
Q

What occurs during normal urine evacuation?

A

Coordinated relaxation of levator ani and external urethral sphincter

Dysfunction can lead to sensory urgency, detrusor overactivity, leakage, obstruction, or retention.

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24
Q

What muscles make up the levator ani?

A
  • Pubococcygeus
  • Iliococcygeus
  • Puborectalis
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25
Q

What is the role of the pubococcygeus muscle?

A

Maintains closure of the urogenital hiatus and elevates the organs

It compresses the vagina, urethra, and rectum towards the pubic bone.

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26
Q

What muscles of the levator ani are anterior and posterior

A

pubbococcygeus is anterior, compresses urogenital hiatus
Illiococcygeus and puborectalis are posterior, attachment point helps stabilize the upper vagina and cervix in horizontal plane to avoid downward F of perineal body

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27
Q

What does the endopelvic fascia do?

A

Surrounds the vagina and attaches the vagina to the ATFP laterally

It helps suspend the urethra on the anterior vaginal wall.

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28
Q

ATFP attachments

A

runs from the pubic bone to the the ischial spine

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29
Q

Levator ani innervation and source of injury

A

L2,3, and maybe 5.
Contribution of pudendal N
can be damaged with sacrospinous fixation for vaginal vault prolapse

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30
Q

What is the function of the guarding reflex?

A

Suppresses micturition during bladder filling

It is a somatic reflex involving contractions of the external urethral sphincter and levator ani.

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31
Q

What is the mechanism of bladder storage

A

stx and fxn components, innervation from purdenal nerve to EUA and LA Nerve to PFM.
* urethral closing pressur e increase from efferent pudenal N efferents and the gaurding reflex

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32
Q

What is the mechanism of bladder emptying

A

inhibition of somatic efferents to EUS by parasympathetic activtion of urethral smooth muscle.

EMPTYING IS PARASYMPATHETIC

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33
Q

What is Hinman’s Syndrome?

A

Acquired voiding dysfunction due to pelvic floor muscles failing to relax normally at the start of urination.

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34
Q

why may pts with painful bladder syndrome have dysfunctional voiding

A

may have bladder outlet obstruction due to dysfuntional voiding and straining

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35
Q

What factors can increase levator ani injury during childbirth?

A
  • Prolonged second stage labor
  • Older maternal age
  • Use of forceps
  • Anal sphincter lacerations
  • Episiotomy
  • childbirth - LA goes through marked distention and can lead to LA avulsion. Detachment of pubbococcygeus form ATPF can reult in levator hiatus distension- irreversable, impaired contractility
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36
Q

What happens to the levator ani muscle during aging?

A

Typically, there is a 30-40% loss of cross-sectional area and volume in striated muscle

However, the levator ani in older nulliparous females shows only a 4.3% decrease.

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37
Q

What is the impact of menopause on pelvic floor structures?

A

Decreased vascularization of levator ani and increased resistance - animal study

Hormone changes can affect pelvic floor structures, especially with earlier surgical menopause.

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38
Q

What is levator ani spasticity?

A
  • A hypertonic pelvic floor dysfunction that forms as a learned behavior in response to adverse events; infection, inflammation, irritation, or trauma
  • Can result in urinary urgency, freuqnecy, and pain - can progress to acquired voiding dysfunction 2/2 difficulty with EAS and levator relaxation to initiate the voiding response
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39
Q

What is the integral theory in relation to urinary incontinence?

A

The vaginal wall functions to prevent urgency and UUI by supporting stretch receptors located in the bladder neck and proximal urethra.

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40
Q

How does SUI happen

A

Connection between the pubocervical fascia and levator ani muscles elevates the bladder neck, provided blackboard for urethral compression- if compromised, insufficient urethral closing pressure can result in SUI during increased intra abdominal pressure
* atrophy of PFM from nerve damage or disruption to endopelvic fascia can weaken urethral support and result in SUI

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41
Q

What is the role of pudendal nerve regeneration in treatment?

A

It has been shown to improve external urethral sphincter EMG in animal studies.

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42
Q

Fill in the blank: The _______ was developed to reinforce the high-pressure zone of the middle urethra.

A

[midurethral sling]

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43
Q

True or False: Aging does not affect the type of muscle fibers in the levator ani.

A

True

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44
Q

What interventions may be used for levator ani spasticity?

A
  • Manual therapy
  • Steroid injections
  • Botox injections
  • Diazepam vaginal suppositories
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45
Q

What can result from the detachment of the pubococcygeus during childbirth?

A

Increased incidence of stress urinary incontinence (SUI) postpartum.

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46
Q

What does the term ‘urethral kinkage’ refer to?

A

A condition caused by advanced stage pelvic organ prolapse leading to bladder outlet obstruction. Can lead to bladder hypo contractility and even urinary retention

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47
Q

What is the ICS definition of nocturia?

A

Complaint to wake at night one or more times to void, each void being preceded and followed by sleep.

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48
Q

What are convenience voids?

A

Wakes up for another reason and feels the desire to pass urine once awake; still considered nocturia.

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49
Q

What constitutes the nocturia index (Ni)?

A

Ni is calculated as nocturnal urine volume (NUV) divided by maximal voiding volume (MVV), and is positive if >1.

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50
Q

What is the criteria for nocturnal polyuria (NP)?

A

An increase in urine production only at night, with NPI = NUV > 20–33% of total 24-h urine volume by age.

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51
Q

what are 4 etiologies leading to nocturia

A

24- Hr
Reduced bladder capacity
Sleep disorders
Noctural polyuria

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52
Q

24 hour polyuria

A

an overall increase of urine production
usually seen in individuals with diabetes mellitus, diabetes insipidus, primary polydipsia, voluntary excessive fluid intake, hypercalcemia, or intake of particular drugs

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53
Q

What can cause nocturnal polyuria?

A
  • Disturbance of endogenous production of arginine vasopressin (AVP) hormone
  • Excess production of atrial natriuretic peptide
  • Nighttime evacuation of daytime third space fluid sequestration
  • meds
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54
Q

What is Nocturnal polyuria [NP]?

A

an increase in urine production only at night
NPI = NUV>20–33% of total 24-h urine volume by age
- peripheral edema/ ANF, secretion, Excess nigtime fluid intake or drinking, circadian rythm defect (AVP PD, MS)Drugs (diretics, ethanols, steriods) Renal tubular failure, obstructive sleep apnea

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55
Q

What is the significance of the nocturnal bladder capacity (NBC)?

A

NBC is overwhelmed by the amount of urine entering the bladder during the night, indicating reduced bladder capacity. this relates to bladder capacity as etiology for nocturia

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56
Q

What does an NBC Index (NBCi) > 0 indicate?

A

Voids at night occur below the MVV, indicating that the bladder cannot store the amount of urine produced at night.

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57
Q

What are some reasons for bladder dysfunction leading to nocturia due to bladder capacity ?

A
  • PBS
  • learned voidign dysfunction
  • pharma
  • lower UI calliculi
  • pelvic massess
  • urogenital prolapse
  • Reduced bladder contractility- BPO
  • Bladder outlet obstruction
  • Detrusor overactivity
  • Primary bladder pathology
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58
Q

Which demographic factors are associated with nocturia?

A
  • Generally greater in women among young adults
  • Greater in men in elderly population groups
  • african american
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59
Q

What lifestyle factors are associated with nocturia?

A
  • Obesity
  • Metabolic syndrome
  • Hypertension
  • Smoking, alcohol, and drug substances
  • winter season
    Increas C reative protien, Lower education, LIfestyle, Reproductive hx in woman, Low testosterone in men
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60
Q

What are the sequelae of nocturia?

A
  • Disturbed sleep
  • independent predictor of mortality in younger patients
  • independent predictor of mortality factor in mortality from coronary heart disease
  • associated with increased overall mortality in the frail elderly population
  • Independent predictor of falls and hip fractures
  • Associated with cardiovascular morbidity;depression; and endocrine, immune, and metabolic disorders
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61
Q

What is the cornerstone of nocturia evaluation according to ICS?

A

The frequency volume chart (FVC) should be used.

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62
Q

What is the Nocturia–Quality of Life (N-QoL) questionnaire used for?

A

To assess the efficacy of therapeutic intervention in clinical trials. higher score = worse

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63
Q

What are some first-line therapeutic interventions for nocturia?

A
  • Lifestyle advice
  • Preemptive voiding before bed
  • Dietary and fluid restrictions
  • evening leg elevation to mobilize fluids
  • use of sleep medications/aides,
  • use of protective undergarments
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64
Q

What medication has shown superiority in reducing nocturnal voids?

A

Furosemide 40 mg taken 6 hours before bedtime.

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65
Q

what role did PFM play in nocturia

A

for urgency at night have been proposed by some for OAB with moderate success

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66
Q

What is the role of desmopressin in the treatment of nocturia?

A

It is a synthetic analogue of vasopressin that aims to concentrate urine at night.drug that has been the most frequently tested for specific management of nocturia

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67
Q

What are some potential side effects of desmopressin?

A
  • Headache
  • Hyponatremia
  • Insomnia
  • Dry mouth
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68
Q

True or False: Surgical or interventional therapy is especially indicated for nocturia.

A

False.
No surgical or interventional therapy is especially indicated for nocturia
Botulinum toxin detrusor injections, sacral neuromodulation, or tibial electric nerve stimulation are used in the context of OAB, but nocturia is always regarded as a secondary outcome
Bladder outlet obstruction surgery has been evaluated in the context of LUTS/BPO, but not really for nocturia

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69
Q

What are some herbal products mentioned for nocturia management?

A

Pygeum africanum and Serenoa repens.

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70
Q

What evidence exists regarding the use of melatonin for nocturia?

A

Data do not support the use of melatonin for nocturia.

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71
Q

What interventions are considered for OAB, but not nocturia, considering it is a secondary outcome to OAB?

A

Botox detrussor injection, sacral neuromodulation/tibial electric nerve stimulation

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72
Q

What is the common way to evaluate therapeutic effect in nocturia?

A

Evaluate the variation in the number of nocturnal voids.

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73
Q

What is the surgical option of choice for SUI?

A

MUS (midurethral slings)

MUS has been established as the preferred surgical procedure for stress urinary incontinence.

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74
Q

Which type of MUS is most likely to work and for longer in patients with intrinsic sphincter deficiency (ISD)?

A

Retropubic MUS

The retropubic approach is more effective for patients with ISD.

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75
Q

What are the complications associated with MUS related to?

A

Surgeon’s experience

The proficiency of the surgeon plays a critical role in the complications arising from MUS.

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76
Q

How do cure rates for SUI compare between retropubic and trans-obturator approaches in the short term?

A

Similar, but retropubic slings are more effective long-term and high risk women

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77
Q

Which approach has a higher risk of visceral injury and bleeding?

A

Retropubic approach

Retropubic slings are associated with increased risks compared to TO and mini slings.

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78
Q

What has caused current interest in bulking agents in SUI management?

A

Negative publicity around mesh devices

Concerns over mesh devices have led to a renewed focus on bulking agents.

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79
Q

What is the effectiveness of MUS compared to Burch colposuspension and fascial pubovaginal slings?

A

Similar long-term effectiveness

Evidence suggests comparable long-term outcomes between these procedures.

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80
Q

What is a significant difference between MUS and previous slings?

A

MUS uses of trocar needles and midurethral placement

MUS utilizes a less invasive technique with trocar needles.

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81
Q

What advantages does MUS offer over Burch colposuspension?

A

Less dissection, fewer complications, less pain, reduced hospital stay. MUS> burch. HOowever there is bad publicuty on mesh with MUS and theres been a decrease in use.

MUS is associated with a more favorable recovery profile.

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82
Q

What are the three main groups of MUS?

A
  • Retropubic MUS - vaginal insertion behind pubic symphysis
  • Transobturator sling (TO)- through obturator foramina
  • Single incision mini slings- avoids retropubic space. little slings mid urethra to obturator fascis

Each group has distinct approaches and characteristics.

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83
Q

What are the risks associated with the TO approach compared to the RP approach?

A

Transobturator sling (TO)- Lower odds of bladder perforation and pelvic hematomas; higher odds of vaginal perforation and groin aches

The Novo urgency has comparable rates with vaginal mesh exposure between RP and TO approaches

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84
Q

What is an operative risk and complications of MUS

A
  • Risk for bladder injury/perforation. 3.8% compared to .4% with TO approach. (Risk for bladder injury comes from inexperienced surgeons, previous C-section, Colopususpension, BMI under 30 use of local anesthesia and rectocele presence)
  • mesh extrusion
  • Bleeding and hematoma with RP
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85
Q

What are independent predictors of MUS failure?

A
  • BMI >25
  • Mixed UI
  • Previous continence surgery
  • Intrinsic sphincter deficiency
  • DM

These factors significantly influence the likelihood of MUS failure.

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86
Q

What is the risk of bladder injury in the RP approach?

A

3.8%

This risk is substantially higher than the TO approach.

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87
Q

What is the reported incidence of vaginal extrusion of synthetic mid urethral sling?

A

2-3%

This is a notable complication associated with MUS.

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88
Q

Which MUS method is better approach in women with intrinsic sphincter deficiency stress urinary incontinence SUI?

A

RP retropubic MUS clear superiority in efficacy

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89
Q

What are advantages and disadvantages to single incision mini slings as MUS option for SUI

A

Advantages: avoidance of risk enterign RP space, less postop pain and easier for less experienced surgeon.
* Expected to have lower cure rates in women with high risks of failure including ISD obesity and previously failed surgery (like TO approach.
* Many slings have inferior efficacy compared to traditional MUS

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90
Q

What is a self-made sling?

A

72% the subjective cure rate
Strips of poly propylene mesh and reusable trocars are in prepackaged shelf kits.
Used for tension free mid urethral placement like original RP or TO slings.

Self-made slings offer a cost-effective alternative with reasonable success.

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91
Q

What are the side effects of vaginal laser treatment for SUI?

A
  • Vaginal warming
  • Increased vaginal discharge
  • Transient urge incontinence
    need more study

These side effects were noted in studies examining laser treatments.

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92
Q

What traditional procedures are compared to MUS?

A
  • Burch colposuspension
  • Fascial pubourethral sling
  • Urethral bulking agents

MUS Long-term effectiveness is good and similar to Burch colposuspension
* Fascial pubourethral sling

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93
Q

What is a disadvantage of urethral bulking agents compared to MUS?

A

Repeated injections necessary, lower morbidity but tend to be more expensive over the long run

Bulking agents require ongoing treatment to maintain effectiveness.

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94
Q

Despite evidence supporting the effectiveness of retropubic MUS, what is notable about the TO approach?

A

High satisfaction rate and usage worldwide.

The TO approach remains popular despite its lower effectiveness. bc avoidance of RP space

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95
Q

What is nocturia?

A

Waking 1+x/night to void

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96
Q

What is the primary evidence-based drug for nocturia?

A

Desmopressin

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97
Q

What must be demonstrated via bladder diary before prescribing desmopressin?

A

Nocturnal polyuria (NP)

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98
Q

What parameters are most used in evaluating nocturnal polyuria?

A
  • Maximum voided volume
  • Void frequency
  • Ratio of nocturnal to 24 hr urine production
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99
Q

How is nocturnal polyuria diagnosed in patients over 65?

A

If more than ⅓ of the 24hr urine volume is produced during the night after excluding 24hr polyuria (>40mL/kg/d)

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100
Q

What is the cutoff for nocturnal polyuria in 21-35 year olds?

A

More than 20% of 24 hr urine

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101
Q

What is the main water regulating hormone?

A

Vasopressin

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102
Q

What conditions are associated with vasopressin deficiency/ resistance?

A
  • Polyuria
  • Polydipsia
  • Diabetes insipidus

Lack of antidiuretic response consequence of low vasopressin

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103
Q

What is the main mechanism for nocturnal polyuria?

A

Abnormal circadian rhythm of vasopressin

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104
Q

What screening tool is used for nocturnal and general symptoms related to sleep disorders?

A

Pittsburgh sleep quality index
The Berlin questionnaire and STOP questionnaire or screening tools for obstructive sleep apnea

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105
Q

True or False: Nocturnal polyuria is higher in Parkinson’s patients than in the control population.

A

False

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106
Q

What condition is associated with nocturia and nocturnal polyuria?

A

Hypertension (HTN)

Children with any enurisis have high nocturnal blood pressure compared to controls

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107
Q

What is the impact of right-sided heart failure on nocturia?

A

Causes fluid retention and swelling, leading to nocturia

Heart failure coincides with renal failure

Leg edema causes NP and nocturia through reabsorption of fluid when supine

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108
Q

Fill in the blank: High intake of ______, ______, or ______ increases kidney excretion and can result in nocturnal polyuria.

A

water, salt, protein

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109
Q

What medications have been shown to increase diuresis?

A
  • Diuretics
  • Antihypertensive meds
  • Progesterone
  • Melatonin
  • Lithium
  • SECT-2 inhibitors
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110
Q

What medications are known to decrease diuresis?

A
  • Antidepressants
  • Antiepileptics
  • Estrogens
  • Testosterone
  • Corticoids
  • NSAIDs
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111
Q

What medication’s cause increased leg edema

A

Antidepressants, antihypertensives, antivirals, Carbones, MSAIDS, some chemotherapeutics and cytokines

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112
Q

What are contraindications for desmopressin?

A
  • CHF (class II-IV)
  • Polydipsia
  • Concomitant medication with high risk of hyponatremia
  • Kidney failure
  • Severe leg edema
  • OSAS
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113
Q

What is the consensus on diagnostic packages for nocturia?

A
  • History taking or questionnaires
  • Blood pressure and edema check
  • Bladder diary (3 days suggested)
  • Post void residual test
  • PSA test, serum sodium check, renal/heart function, endocrine screening when necessary
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114
Q

What level of evidence supports treating OAB and BPO with lifestyle modifications?

A

Level 2 evidence For bladder training, PFT, evening exercise, medication or surgery for nocturia improvement

115
Q

What is a recognized cause of nocturia related to hormonal changes?

A

Low estrogen and menopause

Androgen deprivation is also associated with LUTS and nocturia

116
Q

True or False: Hormone substitution is effective for treating nocturia in postmenopausal women.

A

False

There was a consensus that menopause related nocturia and hot flushed be treated with lifestyle interventions and hormone replacement therapy

117
Q

When should desmopressin be administered?

A

When nocturia occurs without menopausal symptoms

118
Q

What is the follow-up protocol for desmopressin therapy?

A
  • Serum sodium check SSCs necessary on day 3-7 and 1 month
  • Stop if serum sodium is <130 mmol/L
119
Q

How do women compare to men in sensitivity to desmopressin?

A

Women have a higher sensitivity to desmopressin and are more prone to hyponatremia

120
Q

What did study on anterior vaginal repair comparrisons of management options find?

A
  • Similar performance results between interior repair compared to bladder neck single suspension.
  • Not enough data to compare anterior vaginal repair with PT or needle suspension for primary stress urinary incontinence.
  • Open abdominal retropubic suspension better than interior vaginal repair
121
Q

How effective was anterior vaginal repair compared to open abdominal retropubic suspension based on patient-reported cure rates?

A

Anterior repair was less effective

122
Q

What was the cure rate for anterior and abdominal RP repair after 1-5 years?

A

63%
83% abdominal

123
Q

What was the failure rate within 1-5 years for anterior repairand abdominal retropubic suspension? which was better?

A

38%
abdominal retropubic suspension 21%

Interior repair had lower rate of prolapse, repeated operations due to incontinence were 23% for anterior repair versus 2% for retropubic suspension

124
Q

What did the authors conclude about anterior vaginal repair compared to open abdominal retropubic suspension?

A

Open abdominal retropubic suspension appears better

125
Q

What is urodynamic stress incontinence (USI)?

A

Involuntary loss of urine when intravesical pressure exceeds urethral pressure
SUI types include hyper mobile urethra and sphincter deficiency

126
Q

What is the surgical approach of anterior vaginal repair?

A

Surgical approach through vagina

127
Q

Name one surgical method category for urinary incontinence.

A

Open abdominal retropubic suspension

Let’s repeat surgeries needed higher subjective sure rates. Abdominal retropubic suspension with flings may be more effective than anterior repair. But no regrets evidence suggests which is better

128
Q

What may dyspareunia after SUI surgery be more strongly associated with?

A

Posterior repair

Due to narrowing of vaginal introitus

129
Q

Fill in the blank: Anterior vaginal repair is also known as _______.

A

anterior colporrhaphy

130
Q

What is the conclusion of the study on pelvic floor muscle training (PFMT) In those with functional bladder outlet obstruction?

A

PFMT is effective for women with dysfunctional voiding, reducing recurrent UTI and post void residual

The study aims to evaluate how effective PFMT is for addressing this specific health issue.

131
Q

What is Voiding Dysfunction (VD)?

A

Characterized by abnormally slow and/or incomplete micturition, based on abnormally slow urine flow rates and/or raised PVR
May be a result of bladder outlet obstruction BOO or detrusor under activity DU

VD is identified through repeated measurements confirming abnormality.

132
Q

What does the ICS terminology define in relation to voiding dysfunction?

A

A specific and discrete form of voiding dysfunction characterized by an intermittent and/or fluctuating flow rate due to involuntary intermittent contractions of the periurethral striated muscle during voiding in neurologically healthy individuals

This definition helps distinguish between various types of voiding dysfunction.

133
Q

What anatomical causes can lead to bladder outlet obstruction (BOO)?

A
  • Urethral stricture
  • Prolapse
  • Fibrosis
  • Previous pelvic surgical interventions

These anatomical issues can create physical barriers to normal urination.

134
Q

What are the functional causes of bladder outlet obstruction?

A

Non-relaxation of urethra, bladder neck, or whole pelvic floor during voiding phase

This refers to the inability of the pelvic floor muscles to relax properly, affecting urination.

135
Q

What is the main functional treatment for voiding dysfunction?

A

Pelvic Floor Muscle Training (PFMT)

PFMT aims to strengthen pelvic floor muscles to improve urination.

136
Q

What is the bladder contractility index BCI

A

Validated measure to evaluate grade of bladder obstruction outlet in females

Low BCI (< 100): Indicates reduced bladder contractility, often seen in BOO.
Normal BCI (100-150): Considered normal bladder function.
High BCI (> 150): Suggests strong bladder contractions, which may be seen in conditions other than BOO.

gold standard?

137
Q

What urodynamic parameters help differentiate between BOO and detrusor underactivity (DU)?

A

High detrusor pressure with low peak flow rate

These measurements indicate how well the bladder is functioning during urination.

138
Q

What was the protocol for the PFMT in the study For women with functional bladder outlet obstruction?

A
  • Supervised PFMT for 6 months
  • Weekly visits
  • PFM contraction training with internal palpation
  • Diaphragmatic Breathing (DPB)
  • Assisted manual practice
  • Vagina mollification ( down trianing )
  • Radio Frequencies
  • Bladder training including voiding posture
  • Home Exercise Program (HEP)

The structured protocol aimed to comprehensively train pelvic floor muscles.

139
Q

What were the results regarding maximum flow rate after PFMT for BOO?

A

No significant difference

This suggests that while flow rate did not improve significantly, other factors did.

140
Q

What was the effect of PFMT on post-void residual (PVR) for BOO?

A

Significantly reduced

A reduction in PVR indicates improved bladder function.

141
Q

What should PFMT be combined with for effectiveness for BOO?

A

Cognitive/behavioral education and physical training

Combining these elements may enhance the benefits of PFMT.

142
Q

True or False: The study used biofeedback during PFMT for BOO.

A

False

Biofeedback provides information for pts to understand how to modulate muscle function
This study did NOT use biofeedback and still had an improvement in PVR and UTI prevalence

143
Q

What are the risk factors for postpartum urinary retention (PUR)?

A

Epidural analgesia, instrumental delivery, fetal macrosomia, longer labor time

Independent risk factors also include episiotomy, primiparity, and longer second stage of labor.

144
Q

Define overt postpartum urinary retention.

A

Women cannot urinate spontaneously within 6 hours after natural childbirth or 6 hours after removal of indwelling catheter after cesarean.

145
Q

Define covert postpartum urinary retention.

A

Post-void residual (PVR) volume >150mL after first spontaneous urination.

146
Q

What are the potential causes of postpartum urinary retention?

A

Increased demands on bladder capacity, urethral length, urethral closure pressure, and urethral pressure.
Obstruction caused by periurethral and vulvar edema after childbirth that lead to obstruction of bladder outlet d/t overdistention of bladder and permanent damage to detrusor

147
Q

What are some conservative methods for treating postpartum urinary retention?

A

Induced urination with sound of running water, warm compress over bladder, warm baths, perineal rinsing, acupuncture, relaxation and privacy.

148
Q

What pharmacological method is used for postpartum urinary retention?

A

Acupoint or intramuscular injection neostigmine.

149
Q

What is the effectiveness of neostigmine for postpartum urinary retention?

A

70% effective with risks of bradycardia, bronchoconstriction, increased secretions, nausea, vomiting.

150
Q

List some risks associated with catheterization in postpartum urinary retention treatment.

151
Q

List risks and side effects of PUR (PP urinary retention)

A

bladder rupture, upper urinary tract injuries, permanent dysfunction of bladder.

152
Q

What independent risk factor for PUR may cause reflex urethral spasms?

A

Episiotomy.

PUR = poastpartum urinary retention

153
Q

Why might primiparity increase the risk of postpartum urinary retention?

A

More extreme changes and serious damage to pelvic floor musculature.

154
Q

How can longer second stage labor contribute to postpartum urinary retention?

A

More mechanical strength exerted on pelvic floor musculature leading to pelvic, pudendal, and urinary nerve injuries.

155
Q

What complications can arise from instrumental delivery?

A

Urinary neurological disorders, bladder trauma, damage to micturition reflex. leading to risk of postpartum urinary retention

156
Q

How does epidural analgesia affect bladder function?

A

Anesthetizes bladder nerves, inhibiting the reflex mechanism of urination. leading to risk of postpartum urinary retention

157
Q

Fill in the blank: ______ may extend labor duration leading to pelvic floor trauma.

A

Epidural analgesia.

In relation to the bladder, bladder may over descend with epidural if urges inhibited and lead to pelvic floor concerns

158
Q

What aspects should be focused on during the history intake of urinary incontinence in women?

A

Onset, duration, severity, frequency, and effect on quality of life

Determine balance of diagnostic certainty and risk of invassive therapy

159
Q

Is it required to perform an extensive preliminary evaluation for urinary incontinence prior to initial non-invasive treatments?

A

No. Treatment may be begun without clear differentiation between two most common subtypes stress and urgency

160
Q

What are the two most common subtypes of urinary incontinence?

A
  • Stress incontinence
  • Urgency incontinence
161
Q

Define stress incontinence.

A

Involuntary loss of urine with increases in abdominal pressure such as exercise or coughing

162
Q

What is the main etiology of stress incontinence?

A

Poorly functioning urethral closure mechanism

163
Q

List some factors associated with stress incontinence.

A
  • Loss of anatomic support
  • Trauma from vaginal childbirth
  • Obesity
  • Repetitive increase in intra-abdominal pressure
164
Q

Define urgency incontinence.

A

Sudden compelling desire to pass urine that is difficult to defer

165
Q

What characterizes overflow incontinence?

A

Incomplete emptying of the bladder

166
Q

What is the role of urinary microbiota in women with urgency incontinence?

A

Lactobacillus-predominant resident flora may differ in women with urgency incontinence

167
Q

What does the initial incontinence evaluation include?

A
  • History
  • Physical examination
  • Urinary tract infection testing
  • Urinary stress testing
  • Assessment of postvoid residual
168
Q

What is the purpose of urinalysis in urinary incontinence evaluation?

A

Identify urinary tract infection and detect hematuria, pyuria, or glycosuria

169
Q

What is a voiding diary and when should it be performed?

A

Records quantity and timing of fluid intake and urine output during 1 to 3 days, performed when history and urinalysis do not provide a clear etiology. May provide insight on modifible factors

170
Q

What would a pelvic examination include and what findings may indicate urinary retention risk?

A
  • Vaginal atrophy in postmenopausal women- look for atrophy
  • Assess pelvic floor muscle integrity and function with HEP on PFM, not just verbal education with handout
  • Pelvic organ prolapse beyond the vagina- associated with a higher risk of urinary retention
171
Q

What is an additional assessment that can be done to assess stress incontinence

A

In the lithotomic or standing position have patient strain or cough with comfortably full bladder with direct observation of urethra for urine leakage. Predictive value of 78-97%

Urodynamic studies are not necessary in the evaluation of uncomplicated urinary incontinence or before every stress incontinence surgery

172
Q

What is the recommended if medications cause urinary retention?

A

Follow up on signs and symptoms if they increase

173
Q

What is a generally accepted post residual void volume

A

Less than 100 mL for avoided volumes greater than 200 mL or 1/3 of total volume is normal

174
Q

What combined therapy is more successful than drug therapy alone for incontinence?

A

Pelvic floor muscle training (PFMT)

175
Q

What lifestyle modifications are supported by strong evidence for managing incontinence?

A
  • Weight loss in overweight women
  • Smoking cessation
  • Management of constipation
  • Avoidance of excessive fluids and avoidance of irritating fluids
176
Q

What is the recommended fluid management strategy for urinary incontinence?

A
  • Frequent intake of small amounts of fluid (4-5 oz/hour) up to 2 L a day
  • Timed Voiding measures, or voiding at intervals that are tailored to each patient (typically every 2 to 3 hours) during the day
177
Q

What is the typical recommendation for pelvic floor muscle exercise?

A

Thirty contractions per day (3 sets of 10 contractions held for 10 seconds each). Pursue a modality that facilitates compliance- BF, Cone ect.

178
Q

when may bladder control pessaries be used for SUI?

A

are effective / may be preferable for stress urinary incontinence during specific situations; for example, only during exercise

179
Q

True or False: There are FDA-approved medications for stress incontinence.

180
Q

List some medications used for urgency incontinence.

A
  • Darifenacin
  • Fesoterodine
  • Oxybutynin
  • Solifenacin
  • Tolterodine
  • Trospium
  • β-3 Agonist -Mirabegron, the only FDA-approved drug in this class.
  • Estrogen cream, tablet or ring FDA appraived for atrophy
181
Q

What are the adverse effects of anticholinergic medications?

A
  • Constipation
  • Dry mouth
    Anticholinergic medication’s block muscarinic receptors in smooth muscle of bladder to inhibit detrusor contraction to have moderate improvements in urgency frequency urgency
182
Q

What is the only FDA-approved drug for urgency incontinence?

A

Mirabegron (B3 agonist)

183
Q

What are the standard surgical options for stress incontinence?

A
  • Retropubic urethropexy
  • Pubovaginal sling
184
Q

What is the complication rate for midurethral sling procedures?

A

Low, with mesh erosion rates <5%
Mid urethral slings are placed either by retropubic or trans arbitrator approach. Most commonly perform surgery lasting 30 minutes outpatient

185
Q

What is the effectiveness of onabotulinumtoxinA injections for urgency incontinence?

A

65% of patients see effectiveness

186
Q

What is the success rate of a urethral bulking injection versus sling for SUI

A

Lower success rates for injection compared with sling procedures

187
Q

What is sacral neuromodulation for urgency incotnince and its reported improvement rates?

A

Outpatient surgical procedure- implanted electrode placed along third sacral nerve root for nerve stimulation delivery. 60% to 90% of women reporting improvement
DIfferent from PTNS

188
Q

What is the median cure rate for stress incontinence surgery?

189
Q

List the special treatments for urgency incontinence.

A
  • OnabotulinumtoxinA
  • Percutaneous neuromodulators
  • Implanted neuromodulators
190
Q

What is urgency urinary incontinence also termed?

191
Q

What is OAB without UUI called?

192
Q

List three pharmacologic treatments for OAB.

A
  • Anticholinergic therapy (e.g., Detrol, Ditropan)
  • Botulinum toxin (Botox)
  • Mirabegron (Myrbetric)
193
Q

What are the two categories of first-line non-pharmacologic options for OAB?

A
  • Behavioral training
  • Bladder training and lifestyle modifications

require more motivation/compliance

194
Q

What does behavioral training for OAB emphasize?

A

Pelvic floor muscle training (PFMT) to improve bladder control and urge supression techniqes

195
Q

What is a key feature of OAB?

196
Q

How do people with OAB perceive the sensation of desire to void compared to those without OAB?

A

More sudden, intense, and unpleasant

197
Q

What are the two main strategies in physical therapy for OAB?

A
  • Contract and hold to occlude the urethra - leakage prevention
  • Quick contractions to inhibit detrusor contractions- distraction
198
Q

What is the ‘Quick flick’ technique used for?

A

To reflexively inhibit detrusor contraction and prevent internal sphincter relaxation

199
Q

What was the result of combining PFMT with bladder training (BT) compared to BT alone?

A

PFMT + BT was superior for improved quality of life but not for incontinence severity

200
Q

What did Bo et al. conclude about PFMT and OAB symptoms?

A

PFMT might reduce OAB symptoms compared to control interventions

201
Q

What is the theoretical rationale for PFMT for OAB?

A

Strong, but evidence for a specific protocol is lacking

must establish deficit baseline. Cone group had strong PF to begin with, altering results

202
Q

What is one modality that assists PFMT during treatment of OAB? What were the results of the exercise with weighted vaginal cones compared to control?

A

Weighted vaginal cones (WVC)
Both groups had statistically significant improvements, but no difference between groups

203
Q

What is the benefit of electromyographic (EMG) biofeedback in PFMT for OAB?

A

Better outcomes for quality of life and urinary incontinence episodes when comparred to lifestyle group alone

204
Q

What cognitive technique is emphasized for controlling urinary urgency?

A

Thinking of things other than the bladder/urgency sensation. Stay still, dont rush to fulfil urge

IAP increases urgency

205
Q

What is mindfulness in the context of urgency control?

A

Nonjudgmental awareness and responding rather than reacting. Alternative to distraction for urgency control due to other distration techniqes being slightly contradictory- distraction techniques may lengthen reaction times for involuntary sphincter contraction and impair the ability to effectively contract PFM

206
Q

What was the mean decrease in urinary incontinence episodes per day after mindfulness intervention?

A

From 4.14 to 1.23

207
Q

What are some questions to consider regarding PFMT for women with OAB?

A
  • Most effective PFMT training program
  • Differences between OAB with UUI versus OAB without UUI
  • Best cognitive approach to controlling urgency
208
Q

List some advice for managing OAB.

A
  • Decreasing fluid intake before bedtime
  • Reducing caffeine, alcohol, and carbonated beverage consumption
  • Losing weight
209
Q

What is Urodynamics?

A

The general term to describe all of the measurements that assess the function and dysfunction of the LUT by any appropriate method.

210
Q

Define Invasive urodynamics.

A

Any test that involves the insertion of one or more catheters or any other transducer into the bladder and/or other body cavities.

211
Q

What are Non-Invasive urodynamics?

A

Urodynamics done without the insertion of catheters including:
* uroflowmetry
* PVR
* penile compression-release test
* penile cuff
* urethral connector
* condom catheter
* sonography

212
Q

What is included in the ICS standard urodynamics protocol?

A

A pt undergoing:
* clinical history
* relevant clinical examination
* 3 day bladder diary
* uroflowmetry with PVR
* complete ICS standard urodynamic test.

213
Q

What does the ICS standard urodynamic test (SUT) consist of?

A

Uroflowmetry and PVR plus transurethral cystometry and pressure flow study.

214
Q

What is Uroflowmetry?

A

Measures flow rate of the external urinary stream as volume per unit time in millilitres per second (mL/s).Can induce flow pattern.

215
Q

What does Post Void Residual (PVR) measure?

A

The remaining intravesical fluid volume determined directly after completion of the voiding.

216
Q

Define Voided Percentage (Void %).

A

Voiding efficacy or efficiency which is the proportion of the bladder content emptied, calculated as [(volume voided/volume voided + PVR) x 100].

217
Q

What is Cystometry?

A

Continuous fluid filling of the bladder via a catheter, measured with intravesical and abdominal pressure measurement.

218
Q

What is the maximum physiologic filling rate during cystometry?

A

Estimated by body weight (kg)/4; typically 20-30 mL/min.

219
Q

What sensations should patients report during cystometry?

A

First Sensation of Filling (FSF), First Desire to Void (FDV), Strong Desire to Void (SVD), and Urgency.

220
Q

True or False: Current ICS standards require the use of microtip sensors for pressure measurement.

A

False. Instead fluid filled catheters with extra no pressure transducers leveled at height of the upper edge of pubic synthesis is used. Pressure above atmosphere at hydrostatic level up of the pubic synthesis is the standard urodynamic pressure comparison

221
Q

What is Cysto-urethrometry?

A

Cystometry performed with continuous urethral pressure measurement.
find causes of bleeding or blockage
To remove bladder stones, abnormal tissue, polyps, or tumors
To treat urethral strictures or fistulas

222
Q

What is a Pressure-flow study?

A

Intravesical and abdominal pressures are measured from the moment of ‘permission to void’ while uroflowmetry is performed.

223
Q

Define Bladder Outflow Obstruction (BOO).

A

A specified cut-off of bladder outflow resistance based on the pressure flow relation and is considered clinically relevant.

224
Q

What is the purpose of the Urodynamic Stress Test?

A

To examine SUI by elevating abdominal pressure via physcial effort of the person during cystometry.

225
Q

What does the Leak point pressure indicate?

A

The spontaneous or provoked pressure that has caused fluid to be expelled from the bladder.

226
Q

What is the function of pelvic muscle electromyography (EMG)?

A

Pelvic muscle activity is judged with surface electrodes.

227
Q

What does Initial Resting pressure refer to?

A

Pves (Vesicle/ bladder pressure) and pabd (Abdominal pressure) pressure at the beginning of cystometry.

Pdet= detrusor pressure

228
Q

Fill in the blank: A _______ is a signal that is not showing small pressure fluctuations and is not adequately responding to straining.

A

Dead signal.

229
Q

What is Straining in urodynamics?

A

Temporary increase in both bladder pressure and abdominal pressure.

230
Q

What are the recommendations for Pre-Testing information?

A

Clinical history, symptom and bother score, list of medication, urinalysis, and physical exam.

231
Q

True or False: The ICS working group WG recommends routine immediate repetition of invasive urodynamics.

232
Q

What were the two groups in the study measuring TTNS effect on UU?

A
  • Intervention group (PFMT, bladder training, TTNS)
  • Control group (PFMT, bladder training)
233
Q

What is TTNS and how was it administered?

A

Transcutaneous Tibial Nerve Stimulation; 30 min, 1x/week for 12 weeks
Settings:
* Continuous mode
* 10 Hz
* 200 ms
* 10-50 mA

234
Q

What was the aim of electrical stimulation for OAB?

A

To inhibit contraction of the detrusor muscle to reduce urgency and frequency

235
Q

How many TTNS sessions did the treatment group receive?

A

12 sessions, 1x weekly

236
Q

Where were the electrodes placed for TTNS?

A
  • Negative electrode on the medial malleolus of the right ankle
  • Positive electrode placed 10 cm proximal to the negative electrode
237
Q

Which group showed greater improvement in urinary frequency, urgency, and nocturia between TTNS and PFMT, BT and PFMT/ BT ?

A

Both groups showed improvement in urinary frequency, urgency, and nocturia- but the TTNS treatment group were significantly better

238
Q

Was TTNS effective for treating UUI or SUI?

A

Effective for UUI, less so for SUI

239
Q

True or False: Approximately one out of every two patients treated benefitted from electrostimulation of the tibial nerve.

240
Q

At the 12 month follow up, what percentage of the treatment group who reported satisfaction had recurrence of symptoms?

A

68%

most repeated the treatment

241
Q

What was the conclusion of the ESTEEM RCT study for behavioral + PFMT with surgery vs, surgery alone for mixed urinary incontinence management?

A
  • The combined group had greater improvements in UDI outcome but between group differences did not meet MCID. * Participants did not receive treatment prior to surgery and still improved.
  • Conclusion: Among women with MUI the addition of perioperative behavioral and PFMT to mid urethral sling surgery resulted in a difference in urinary incontinence symptoms that may not be clinically important
242
Q

What percentage of women experience urinary incontinence postpartum?

A

1/3rd of women

This statistic highlights the prevalence of UI among postpartum women.

243
Q

What percentage of women experience fecal incontinence postpartum?

A

1/10th of women

This statistic indicates the occurrence of FI in postpartum women.

244
Q

Does antenatal PFMT probably reduce the risk of urinary incontinence in late pregnancy for *continent women?

A

Yes

The evidence suggests a likely benefit of PFMT for this group.

245
Q

What is the effect of antenatal PFMT on urinary incontinence in the mid-postnatal period?

A

Slightly reduced risk. Insifficinet evidence for late preganacy

This indicates a potential benefit, though the effect is minimal.

246
Q

Is there sufficient evidence for late postnatal period urinary incontinence prevention through PFMT?

A

No

Evidence is insufficient to support the effectiveness of PFMT in this timeframe.

247
Q

What does the evidence say about antenatal PFMT in *incontinent women during late pregnancy?

A

No evidence that it decreases UI

This suggests that PFMT may not be effective for those already experiencing UI.

248
Q

Does PFMT change urinary incontinence in women with persistent UI at >6-12 months postpartum?

A

No evidence

This indicates a lack of effectiveness for long-term UI management.

249
Q

What approach is suggested for urinary incontinence risk in late pregnancy?

A

Mixed prevention and treatment approach

This approach encompasses both preventative and treatment strategies.

250
Q

What is the effect of antenatal PFMT on mid-postnatal period risk of urinary incontinence?

A

Slightly reduced risk

This suggests a minor benefit of PFMT in this phase.

251
Q

Is there evidence that antenatal PFMT reduces the risk of urinary incontinence at late postpartum?

A

No evidence

This shows a lack of support for PFMT’s effectiveness in this later stage.

252
Q

Is it uncertain if PFMT reduces fecal incontinence in the late postnatal period compared to usual care?

A

Yes

There is ambiguity surrounding the effectiveness of PFMT for FI in this context.

253
Q

What does the evidence say about antenatal PFMT changing the prevalence of fecal incontinence in late pregnancy?

A

No evidence

This indicates that PFMT may not influence FI prevalence during late pregnancy.

254
Q

Does postnatal PFMT reduce the risk of fecal incontinence in the late postnatal period?

A

No evidence

This highlights the lack of support for PFMT’s effectiveness in this timeframe.

255
Q

What may early, structured PFMT in early pregnancy do?

A

study conclusion: prevention of onset of urinary incontinence in late pregnancy and postpartum

This suggests a proactive approach to managing UI risk.

256
Q

What is uncertain about the effects of PFMT as a treatment for urinary incontinence in antenatal and postnatal women?

A

Uncertainty surrounds its effects

This indicates a need for further research on PFMT’s treatment efficacy.

257
Q

What is Overactive Bladder (OAB)?

A

A constellation of symptoms including urgency, frequency, nocturia, and/or urinary urge incontinence

Prevalence in Men: 7%-27%; Women: 9%-43%

258
Q

What are the first and second line treatments for OAB?

A

First line: behavioral; Second line: pharmacological

259
Q

What percentage of people with OAB progress to third line treatments?

A

Less than 5%
percutaneous tibial nerve stimulation (PTNS), sacral nerve modulation (SNM) or onabotulinum A injections

260
Q

What negative impacts does OAB have on quality of life?

A
  • Higher rates of depression
  • Poor quality of sleep
  • Decreased sexual satisfaction
  • Low work productivity
  • Decline in general health
261
Q

How does stigma affect older women with OAB?

A

Leads to delaying seeking help, resulting in suffering

262
Q

According to the ICS, how is OAB defined?

A

Urinary urgency usually accompanied by daytime frequency and/or nocturia with or without urinary incontinence

263
Q

What are the patient-reported outcome measures for OAB?

A
  • Bladder diary
  • Symptom questionnaire
  • QoL questionnaires
  • OAB-q and OAB-q short form
  • ICIQ-UI-SF
  • PBCQ
  • OAB-SAT SF
264
Q

What must be ruled out during the evaluation and treatment of OAB?

A

Metabolic conditions and urinary tract infection (UTI)

265
Q

How to distinguish OAB from wet and dry

A

Bladder scan, bladder diary, and pad test may be completed to differentiate wet from dry OAB

266
Q

What are some first line treatment lifestyle modifications for OAB?

A
  • Adequate daily fluid intake
  • Weight management
  • Smoking cessation
  • Timed voiding
  • Bowel regularity
  • Elimination of bladder irritants
  • Pelvic floor muscle exercises
267
Q

What is the theoretical risk of reducing fluid intake in OAB patients?

A

Increased frequency due to concentrated urine

268
Q

What is the relationship between obesity and OAB wet?

A

Obesity is a modifiable risk factor; individuals with BMI > 30 are 2.2 times more likely to suffer from OAB wet than those with BMI < 24.8

269
Q

What dietary irritants should be avoided to reduce OAB symptoms?

A
  • Caffeine
  • Artificial sweeteners
  • Tomato products
  • Citrus
  • Coffee
  • Tea
  • Sodas
  • Alcohol
270
Q

What are strategies based off bladder diary that can be used to address OAB

A
  • Urge inhibition using time voiding as distraction technique.
  • Double voiding to facilitate complete bladder emptying or position changes.
  • Address constipation - Low bladder volume with those with constipation which can provoke urinary urgency and frequency. Higher rates of constipation in OB patients
271
Q

what is the relationship between bowel and OAB

A
  • Address constipation - Low bladder volumes seen in those with constipation which can provoke urinary urgency and frequency. Higher rates of constipation in OB patients
272
Q

What are the side effects of pharmacologic interventions for OAB?

A
  • Dry mouth
  • Constipation
  • Urinary retention
273
Q

What medication is a beta 3 agonist used for patients who cannot use antimuscarinics?

A

Myrbetriq

For those who cannot use antimuscarinics

274
Q

What are the success rates of PTNS for OAB treatment?

275
Q

What is a contra indication for anti-cholinergics

A

Elderly patients with narrow angle glaucoma constipation and dementia

276
Q

What are the contraindications for sacral neuromodulation?

A
  • Pacemakers
  • Defibrillators
  • Cognitive decline
277
Q

What risks are associated with the use of Botox for OAB?

A
  • Urinary retention
  • Risk of UTI
  • Reluctance to perform Clean Intermittent Catheterization (CIC)
278
Q

Is botix recommnded for OAB

A

yes - 3rd lin tx
FDA approved in 2013 as a therapeutic option for refractory neurogenic overactivity and idiopathic overactivity
Results in statistically significant improvements in urgency, frequency, nocturia, and leakage

279
Q

Is sacro neuromodualtion an effective tx for OAB?

A

yes - third line, Stimulating sacral nerve to relax the detrusor. trial of PTNS done first

280
Q

Fill in the blank: A bladder diary helps to determine bladder capacity and individualize _______.

A

toileting schedule

281
Q

For LUTS in postpartum women how can strength via PFMT be improved?

A

Combined with biofeedback and electrical stimulation

282
Q

What were the findings of combining pelvic floor muscle training with biofeedback and electrical stimulation for women in postpartum for LUTS

A

Reduced one hour leakage, improved QOL scores, elevated abdominal leak point pressure (ALPP). All compared to PFMT alone

283
Q

What were the findings of combining pelvic floor muscle training with electrical stimulation for women in postpartum for LUTS

A

Improved therapeutic affect, better strength, improved urine leakage- one hour more than PFMT alone-, higher QOL score, improved maximum urethral close pressure and flow rate and reduced void time all compared to PFMT alone

284
Q

How long should PFMT training before in the postpartum population and what can be added as a modality to help with pelvic floor perception

A

8 weeks. Add ES to help with improvement in the perception of pelvic floor muscle contraction.

WCS (12 decks)

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