29/2 Uterine Prolapse

Question 1

What is urinary incontinence

Answer 1

uncontrollable leakage of urine w/ 5 types

Stress incontinence

Urge incontinence

Mixed incontinence

Total incontinence

Other, assoc w/ scoliosis and spinal cord injury

Question 2

Causes of urinary incontinence

Answer 2

DIAPPERS:
Delirium/Dementia

Infection(reccuring UTI)

Atrophic urethritis/vaginitis

Pharmaceutical(alcohol, caffeine, diuretics)

Psychiatric causes (especially depression)

Excessive urinary output (hyperglycemia, hypercalcemia, CHF

Restricted mobility, spinal injury, scoliosis

Stool impaction.

Question 3

Causes of stress incontinence

Answer 3

Increased intra-abdominal pressure ( laughing, sneezing, coughing, exercising) → ↑ pressure within the bladder overcomes sphincter resistance
OR

Urinary hypermobility d/2 Poor pelvic support caused by

• pelvic postmenopausal estrogen loss,
• connective tissue disorders,
• childbirth (i.e., damage of the pelvic floor muscle levator ani and/or the S2–S4 nerve roots

Question 4

Sx of stress incontinence

Answer 4

Leakage of urine upon activities that increase abdominal pressure

Question 5

Rx of stress incontinence

Answer 5

General principles of treatment of urinary incontinence

Duloxetine: SNRI

surgery

Question 6

Causes of urge incontinence (involuntary contraction of the detrusor muscle)

Answer 6

Inflammatory conditions (vaginitis) or neurogenic disorders (spinal injury/ dementia)
→ sphincter dysfunction, overactivity of detrusor or overactive bladder
→ autonomous contractions of the detrusor muscle
→ premature initiation of a normal micturition reflex
Leakage of urine

Question 7

Sx of urge incontinence

Answer 7

Sudden sense of urgency and involuntary leakage

Question 8

Rx of urge incontinence

Answer 8

General principles

Anticholinergic medication

Surgery

Question 9

Causes of mixed incontinence

Answer 9

Combination of causes of stress and urge incontinence

Question 10

Sx of mixed incontinence

Answer 10

Clinical features of both stress and urge

Question 11

Rx of mixed

Answer 11

General principles

Anticholinergics to Rx the urge aspect

Question 12

Cause of total incontinence

Answer 12

Total loss of sphincter function d/2
-surgery, metastasis, nerve damage

Abnormal anatomy of sphincter
-fistula bet/w urinary tract and skin

Question 13

Sx of total incontinence

Answer 13

CONSTANT urinary leakage w/o triggers

Question 14

Rx of total incontinence

Answer 14

General principles

Usually surgery

Question 15

Causes of overflow incontinence

Answer 15

Impaired contraction of detrusor muscle
-usually d/2 anticholinergic medications

Bladder outlet obstruction d/2 mech/ functional block such as BPH, urethral stricture and posterior urethral valves

→ chronic distended bladder with ↑ bladder pressure

→ dribbling of urine when intravesical pressure overcomes sphincter outlet resistance

Question 16

Sx of overflow incontinence

Answer 16

Frequent, involuntary dribbling of urine in the absence of an urge to urinate

Can be continuous or intermittent

Occurs only when the bladder is full

Often occurs with changes in position

Question 17

Rx of overflow incontinence

Answer 17

Acute settings: intermittent catheterization

Timed voiding for day to day management

Treatment of underlying condition

Question 18

What are the other causes of urinary incontinence

Answer 18

Commonly seen in multiple sclerosis or spinal cord injury

Detrusor sphincter dyssynergia! =
simultaneous contractions detrusor muscle and activation of the internal urethral sphincter

Causes blockage of bladder outlet

small amounts of urine are pressed through the contracted sphincter muscle

This causes high intravesical pressure along with inappropriate contraction of the urethral sphincter

Question 19

Sx of detrusor sphincter dyssynergia

Answer 19

Voiding dysfunctions

Intermittent voiding

Urinary retention

Small volume

Reflex incontinence: leakage of urine w/o urge to void

Question 20

Rx of detrusor sphincter dyssynergia

Answer 20

General principles

Injection of botulinum toxin into detrusor. paralysis prevents involuntary contractions for ∼ 6 months

Transurethral resection of external urinary sphincter (TURS)

Alpha-blockers and/or anticholinergics

Urethral stent placement
Implantation of a bladder pacemaker

Surgical insertion of the pulse generator at the S2–S4 ventral root

Question 21

Dg tests for urinary incontinence

Answer 21

General dg
Detailed medical history (including medication)
Voiding diary to assess frequency and volume of micturition
Neurological, vaginal, and rectal examination

Laboratory tests
Urine dipsticks and urine culture to exclude urinary tract infections
Creatinine and blood urea nitrogen (BUN)

Imaging
Renal ultrasound
Urodynamic examination to measure bladder pressure and urethral closure pressure

Cystoscopy to rule out tumors and vesicorectal or vesicovaginal fistulae

MRI to identify pelvic floor defects

Question 22

Rx of urnary incontinence

Answer 22

Remove causes( drugs etc)

Leakage prevention
-catheter, pessaries,

Lifestyle changes
-weight loss, diet etc

Behavioural therapy
-kegel excercise, bladder training,

Medication
-topical vaginal estrogen for postmenopause
-

Question 23

Complication of urinary incontinence

Answer 23

General: depression, psychosocial distress

prolonged contact with urine: dermatitis, skin infections, and sores

Urinary tract: increased risk of urinary tract infections