28 - Urinary Incontinence

Question 1

Urinary incontinence:

Answer 1

Involuntary leakage of urine

Question 2

Normal ethereal closure extrinsic and intrinsic factors:

Answer 2

— extrinsic:
1- Levator ani muscles
2- Endopelvic fascia

— intrinsic
1- striated muscles and smooth muscles
2- vascular congestion of the submucosa venous plexus

Question 3

Bladder filling registering receptors and their mechanism:

Answer 3

The tension stretch receptors which register the bladder Fullness to almost half of the bladder before initiating the micturition reflex through signals to the brain

Question 4

Resistance during bladder filling:

Answer 4

Increases

Question 5

Detrouser muscle during the bladder filling:

Answer 5

Should Remain inactive during bladder filling without involuntary Contractions

Question 6

Bladder innervation and their function:

Answer 6

1– sympathetic: T11–L2/3, innervates the alpha receptors (increases the urethral tone and promotes closure) and the beta receptors (decreases the bladder body tones)
2– parasympathetic: S2–S4, bladder motor functions (bladder contraction and emptying)
3– somatic nervous system: S2–S4, pelvis floor, urethra and external urethral sphincter

Question 7

Stress incontinence:

Answer 7

Involuntary leakage with sneezing, coughing, laughing or anything that increases the intra abdominal pressure

Question 8

Urge incontinence:

Answer 8

Overactive detrouser Muscle and bladder causing a sudden urge to urinate

Question 9

Overflow incontinence:

Answer 9

Impaired detrouser muscle or bladder outlet obstruction

Question 10

Other causes of the urinary incontinency:

Answer 10

1- DM
2- Neurological causes: Parkinson’s, stroke, Multiple sclerosis, spinal cord injuries and disc hernia
3- alpha blockers
4- Decrease mobility Post surgery

Question 11

Alarming symptoms:

Answer 11

1- change in gait
2- mental status change
3- sudden onset of incontinence
4- abdominal or pelvis pain
5- hematuria

Question 12

Physical examination for urinary incontinence:

Answer 12

1- inspect foot sign of atrophy and inflammation
2- evaluated for masses and tenderness
3- bladder stress test: Stand, reflex and cough
4- pelvic organ prolapse

Question 13

Investigations:

Answer 13

1- urine analysis
2- post void residual volume: 200 or more suggests detrouser weakness or bladder outlet obstruction
3- urodynamic testing: 2 types; cystometry to evaluate bladder function by measuring pressure and volume of fluid in bladder during filling storage and voiding and uroflowmetry for the taste of urine flow

Question 14

Slide29

Answer 14

Am so done