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Senior - Urology > 7 - Urinary Incontinence > Flashcards

7 - Urinary Incontinence Flashcards

1
Q

Definition of incontinence?

A

Involuntary loss or leakage of urine

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2
Q

Continence is dependent on:

A

Complaint reservoir

Efficient sphincter

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3
Q

Components of efficient sphincter?

A

Involuntary smooth muscle of bladder neck

Voluntary skeletal muscle of external sphincter

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4
Q

Bladder anatomy

A

Slide 9

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5
Q

Risk factors for incontinence women

A 
Obesity
Age
Multiparity
Mode of delivery (vaginal)
Fam hx
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6
Q

Risk factors for incontinence men

A 
Age
Prostate disease
UTI hx
Constipation
DM
Neurologic disease
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7
Q

Causes of incontinence?

A

Transient causes
- potentially reversible

Established causes

  • lower UT pathophysiology
  • age related physiologic changes
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8
Q

Transient causes

A

Diappers

Slide 12 if you want

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9
Q

Established causes?

A 
Detrusor overactivity
- urge incontinence
Urethral incontinence
- stress incontinence 
Urethral obstruction
Detrusor underactivity
- overflow incontinence
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10
Q

Types of incontinence?

A 
Total 
- continuous 
Stress
Urge
Overflow
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11
Q

Causes of total incontinence?

A

Loss of sphincter efficiency
Presence of fistulas 2/2
- pelvic/vag surgery
- diverticulitis

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12
Q

Tx for total incontinence?

A

Surgery

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13
Q

Most important step in eval of total incontinence?

A

Hx

  • degree of leakage
  • relation to activity, position, bladder fullness
  • timing of onset
  • progression
  • PMH
  • PSH
  • meds
  • OB hx
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14
Q

PE tests for total incontinence

A 
GU 
- pelvic exam
GI 
- rectal exam 
Neuro

Stress test
- pt coughs when standing and full bladder

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15
Q

Labs for total incontinence?

A

UA + culture (UTI)
BUN/creatinine (renal function)
PSA

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16
Q

Special test for total incontinence?

A

Post-void residual urine volume

Cystogram
- fistuals or bladder neck

Urodynamic studies (not routine)

  • cystometery
  • uroflow testing
17
Q

What is stress incontinence?

A

Instantaneous urine leakage in response to stress maneuver

- “urethral incontinence”

18
Q

Prevalence of stress incontinence?

A

2nd MCC in older women

1st MCC in men w prostatectomy

19
Q

When is stress incontinence worst?

A

During the day

- unless another abnormality is present (i.e. detrusor overactivity)

20
Q

Positive incontinence stress test?

A

Cough while standing -> leakage

21
Q

Stress incontinence is associated w?

A 
Pelvic floor laxity
Poor support of vesicourethral sphincter unit
- multiparous women
- pelvic surg
- prostate surg
22
Q

Tx for stress incontinence

A 
Kegel
Lifestyle 
- caffeine/fluids
- wt loss
Pessaries/vag cones
Surgery
- sling surgery
23
Q

Success of sling surgery?

A

96%

24
Q

Sling surgery?

A

Slid 25 has pics

- its just what it sounds like

25
Q

MCC of incontinence (2/3 of geriatric incontinence causes)

A

Urge incontinence

- detrusor overactivity

26
Q

Overactive bladder?

A

Detrusor overactivity

- uninhibited bladder contractions -> leakage

27
Q

Causes of urge incontinence?

A

Idiopathic

28
Q

Men w urge incontinence?

A

Commonly coexists w urethral obstruction from BPH

29
Q

If pt has abrupt or unexplained onset of detrusor overactivity?

A

Cytoscopy or urine cytology

- r/o stones and tumor

30
Q

Tx for urge incontinence? (Non-pharm)

A

Bladder training (1st line)
Lifestyle mods
Timed and prompted voiding
Kegel exercises

31
Q

Tx for urge incontinence? (pharm)

A

Anti-muscarinics (1st line pharm)

  • tolterodine
  • oxybutynin
  • fesoterodine
  • solifenacin

Anti-spasmodic
- mirabegron

Onabotlin toxin a
- inj into detrusor

32
Q

Least common cause of overflow incontinence

A

Detrusor underactivity

33
Q

Cause of detrusor underactivity?

A

Idiopathic

Sacral lower motor nerve dysfunction

Chronic urinary retention

34
Q

Common lab finding for detrusor underactivity

?

A

H postvoiding residual urine

35
Q

Tx for overflow incontinence?

A

Augmented voiding techniques

  • double voiding,
  • suprapubic pressure

Intermittent or indwelling catheter

36
Q

Urethral obstruction is due to/?

A
  • Prostate enlargement
  • Urethral stricture
  • Bladder neck contracture
  • Prostatic cancer
37
Q

Presentation of urethral obstruction?

A

Post-voiding dribbling
Urge incontinence
Overflow incontinence

38
Q

Tx for urethral obstruction?

A

Surgical decompression (most effective)

Intermittent indwelling catheter

Alpha-blockers

  • terazosin
  • prazosin
  • tamulosin
39
Q

Did you know that the first 🍟 weren’t cooked in france?

A

They were cooked in greece

Senior - Urology (7 decks)

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