16: Urinary incontinence and pelvic prolapse: Pathophysiology, evaluation, and medical management Flashcards
Define “Urinary incontinence”.
Complaint of any involuntary leakage of urine.
What symptom describes the complaint of involuntary leakage on effort, exertion, sneezing, or coughing?
Stress urinary incontinence.
Describe the symptom of “Urgency” in urinary incontinence.
Complaint of a sudden compelling desire to pass urine, which is difficult to defer.
What is “Urgency urinary incontinence”?
Complaint of involuntary leakage accompanied by or immediately preceded by urgency.
Which type of incontinence is described as a voluntary loss of urine associated with a change of body position, such as rising from seated or lying positions?
Postural incontinence.
Define “Nocturnal enuresis”.
Complaint of involuntary loss of urine that occurs during sleep.
What term describes involuntary leakage associated with both urgency and activities like exertion, effort, sneezing, or coughing?
Mixed incontinence.
What does “Continuous urinary incontinence” refer to?
Complaint of continuous leakage.
Which type of incontinence occurs when the woman is unaware of how the urinary incontinence happened?
Insensible incontinence.
Define “Coital incontinence”.
Complaint of involuntary loss of urine with coitus.
What pharmacologic agents are classified as Sympathomimetics that can affect the lower urinary tract?
Ephedrine, methylphenidate, cocaine, amphetamine.
What potential effects on the urinary tract can Sympathomimetics cause?
They can increase outlet resistance, exacerbate obstructive symptoms/overactive bladder symptoms, decrease detrusor contractility, and precipitate retention.
Name the pharmacologic agents classified as Sympatholytics.
Terazosin, doxazosin, tamsulosin, alfuzosin, silodosin.
What is the potential effect of Sympatholytics on the urinary tract?
What is the potential effect of Sympatholytics on the urinary tract?
Which agents are categorized as Anticholinergics that might impact the lower urinary tract?
Oxybutynin, fesoteridine, solifenacin, trospium, darifenacin.
How do Anticholinergics potentially affect the urinary tract?
They can contribute to urinary retention, especially in patients with outlet obstruction.
List the pharmacologic agents that are Diuretics, as per the table.
Furosemide, thiazides, spironolactone, triamterene, bumetanide.
How do Diuretics directly affect the bladder?
They do not affect the bladder directly. However, due to increased urine production, they can aggravate incontinence problems.
What are the main components assessed during a focused pelvic examination?
External genitalia and vagina, urethra, bladder, cervix, uterus, adnexa/parametria, and anus and perineum.
When examining the external genitalia and vagina, what aspects related to general appearance are assessed?
Hair distribution, the presence of lesions, estrogen effect, and discharge.
During the pelvic examination, which structures are checked for general appearance, lesions, and discharge?
External genitalia, vagina, and cervix.
Which pelvic structures are evaluated for masses, tenderness, and other conditions during the examination?
Urethra, bladder, cervix, uterus, and adnexa/parametria.
How is the uterus examined during a focused pelvic examination?
It is evaluated for size, contour, position, mobility, tenderness, consistency, descent, or support
When assessing the adnexa/parametria during the pelvic examination, which conditions or signs should be looked for?
Masses, tenderness, organomegaly, and nodularity.
Based on modern medical practices, why might a detailed assessment of the vagina’s estrogen effect be crucial for post-menopausal women?
Lower estrogen levels post-menopause can lead to vaginal atrophy, with symptoms like dryness, irritation, and dyspareunia, impacting quality of life and sexual function.
During a pelvic examination, what are the primary concerns when inspecting the anus and perineum?
During a pelvic examination, what are the primary concerns when inspecting the anus and perineum?
What are the criteria for Stage 0 in the Baden-Walker Classification and the POP-Q Staging Criteria?
Aa, Ap, Ba, Bp at –3 cm, and C or D ≤ – (tvl – 2) cm
Which stage in the Baden-Walker Classification and the POP-Q Staging Criteria has criteria that do not meet Stage 0 and has a leading edge < –1 cm?
Stage I
For which stage is the leading edge ≥ –1 cm but ≤ +1 cm in the Baden-Walker Classification and the POP-Q Staging Criteria?
Stage II
Which stage in the Baden-Walker Classification and the POP-Q Staging Criteria has a leading edge that’s more than +1 cm but less than + (tvl – 2) cm?
Stage III
In the Baden-Walker Classification and the POP-Q Staging Criteria, for which stage is the leading edge ≥ + (tvl – 2) cm?
Stage IV
If a patient has a leading edge of exactly +1 cm based on the Baden-Walker Classification and the POP-Q Staging Criteria, which stage would they fall under?
Stage II
