7 - Urinary Incontinence Flashcards
Definition of incontinence?
Involuntary loss or leakage of urine
Continence is dependent on:
Complaint reservoir
Efficient sphincter
Components of efficient sphincter?
Involuntary smooth muscle of bladder neck
Voluntary skeletal muscle of external sphincter
Bladder anatomy
Slide 9
Risk factors for incontinence women
Obesity Age Multiparity Mode of delivery (vaginal) Fam hx
Risk factors for incontinence men
Age Prostate disease UTI hx Constipation DM Neurologic disease
Causes of incontinence?
Transient causes
- potentially reversible
Established causes
- lower UT pathophysiology
- age related physiologic changes
Transient causes
Diappers
Slide 12 if you want
Established causes?
Detrusor overactivity - urge incontinence Urethral incontinence - stress incontinence Urethral obstruction Detrusor underactivity - overflow incontinence
Types of incontinence?
Total - continuous Stress Urge Overflow
Causes of total incontinence?
Loss of sphincter efficiency
Presence of fistulas 2/2
- pelvic/vag surgery
- diverticulitis
Tx for total incontinence?
Surgery
Most important step in eval of total incontinence?
Hx
- degree of leakage
- relation to activity, position, bladder fullness
- timing of onset
- progression
- PMH
- PSH
- meds
- OB hx
PE tests for total incontinence
GU - pelvic exam GI - rectal exam Neuro
Stress test
- pt coughs when standing and full bladder
Labs for total incontinence?
UA + culture (UTI)
BUN/creatinine (renal function)
PSA
Special test for total incontinence?
Post-void residual urine volume
Cystogram
- fistuals or bladder neck
Urodynamic studies (not routine)
- cystometery
- uroflow testing
What is stress incontinence?
Instantaneous urine leakage in response to stress maneuver
- “urethral incontinence”
Prevalence of stress incontinence?
2nd MCC in older women
1st MCC in men w prostatectomy
When is stress incontinence worst?
During the day
- unless another abnormality is present (i.e. detrusor overactivity)
Positive incontinence stress test?
Cough while standing -> leakage
Stress incontinence is associated w?
Pelvic floor laxity Poor support of vesicourethral sphincter unit - multiparous women - pelvic surg - prostate surg
Tx for stress incontinence
Kegel Lifestyle - caffeine/fluids - wt loss Pessaries/vag cones Surgery - sling surgery
Success of sling surgery?
96%
Sling surgery?
Slid 25 has pics
- its just what it sounds like
MCC of incontinence (2/3 of geriatric incontinence causes)
Urge incontinence
- detrusor overactivity
Overactive bladder?
Detrusor overactivity
- uninhibited bladder contractions -> leakage
Causes of urge incontinence?
Idiopathic
Men w urge incontinence?
Commonly coexists w urethral obstruction from BPH
If pt has abrupt or unexplained onset of detrusor overactivity?
Cytoscopy or urine cytology
- r/o stones and tumor
Tx for urge incontinence? (Non-pharm)
Bladder training (1st line)
Lifestyle mods
Timed and prompted voiding
Kegel exercises
Tx for urge incontinence? (pharm)
Anti-muscarinics (1st line pharm)
- tolterodine
- oxybutynin
- fesoterodine
- solifenacin
Anti-spasmodic
- mirabegron
Onabotlin toxin a
- inj into detrusor
Least common cause of overflow incontinence
Detrusor underactivity
Cause of detrusor underactivity?
Idiopathic
Sacral lower motor nerve dysfunction
Chronic urinary retention
Common lab finding for detrusor underactivity
?
H postvoiding residual urine
Tx for overflow incontinence?
Augmented voiding techniques
- double voiding,
- suprapubic pressure
Intermittent or indwelling catheter
Urethral obstruction is due to/?
- Prostate enlargement
- Urethral stricture
- Bladder neck contracture
- Prostatic cancer
Presentation of urethral obstruction?
Post-voiding dribbling
Urge incontinence
Overflow incontinence
Tx for urethral obstruction?
Surgical decompression (most effective)
Intermittent indwelling catheter
Alpha-blockers
- terazosin
- prazosin
- tamulosin
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They were cooked in greece
