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RDS Test 3 > B8.049 Prework: Adult Urinary Incontinence > Flashcards

B8.049 Prework: Adult Urinary Incontinence Flashcards

1
Q

what is urinary incontinence

A

complaint of involuntary loss of urine

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2
Q

what is urinary incontinence a risk factor for

A 
prolonged hospitalization
falls
UTI
contact dermatitis
institutionalized care
depression/anxiety, social isolation
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3
Q

epidemiology of UI

A

15-30% of older adults

up to 50% of patients in nursing facilities

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4
Q

types of UI

A 
stress
urge
mixed
overflow
neurogenic
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5
Q

stress UI

A

involuntary leakage on exertion/physical activity, or on sneezing or coughing (anything that increased intraabdominal P)

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6
Q

urge UI

A

involuntary leakage associated with urgency

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7
Q

mixed UI

A

involuntary leakage associated with urgency and also with exertion, sneezing, or coughing

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8
Q

overflow

A

involuntary leakage associated with incomplete bladder emptying

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9
Q

neurogenic

A

incontinence related to an underlying neurologic disease

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10
Q

bladder overactive

A

urgency

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11
Q

sphincter underactive

A

stress

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12
Q

bladder underactive

A

overflow

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13
Q

urethral obstruction

A

overflow/urgency

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14
Q

CNS structures involved in micturition

A

periaqueductal gray
pontine micturition center
onuf’s nucleus

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15
Q

neural regulation of urine storage

A

guarding reflex
during bladder filling:
-afferent nerve inputs stimulate sympathetic output to bladder and proximal urethra
-pudendal firing activated to control external sphincter
GOAL: bladder relaxation, icnreased outflow resistance

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16
Q

hypogastric nerve

A 
T10-L2
sympathetic
contracts bladder outlet
inhibits detrusor
B3 receptors in bladder
a1 receptors in internal sphincter
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17
Q

pudendal nerve

A

somatic control of external sphincter

ACh receptors

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18
Q

neural regulation of emptying

A

termination of inhibitory signals from periaqueductal grey to pontine micturition center

  • descending signals inhibit guarding reflex
    1. urethral sphincter relaxation by inhibition of Onuf’s nucleus
    2. activation of parasympathetic pathways
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19
Q

pelvic nerve

A 
S2,3,4
parasympathetic
M2, M3 receptors in bladder
contracts detrusor 
inhibits bladder outlet
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20
Q

summary of filling/storage phys

A

bladder accommodates increasing volumes of urine at low pressures by:
-inhibition of the parasym system provided by sym and somatic reflex activity
bladder outlet must remain closed during filling phase by spinal reflex activity that activates sym and somatic pathways (guarding reflex)

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21
Q

summary of emptying phys

A

when ready to empty bladder, PAG activates PMC which causes micturition via parasym pathways in sacral cord
sym and somatic nerves are inactive
bladder outlet open

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22
Q

symptoms of stress UI

A

leakage of urine associated with physical activity, coughing, sneezing
can also be seen in men after prostate surgery

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23
Q

symptoms of urgency incontinence

A

sudden need to void but cant get to the toilet fast enough

“overactive bladder”

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24
Q

symptoms of overflow incontinence

A

sensation of abdominal fullness
dribbling of urine
intermittent urine stream

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25
risk factors for UI
``` gender (2x more in women) age (younger = stress, older=urge) pregnancy (stress in 40%) parity smoking obesity diabetic neuropathy ```
26
reversible causes of UI
``` delirium, dementia infection atrophic vaginitis psychosocial: depression pharma endocrine disorders restricted mobility stool impaction ```
27
drugs that can cause UI
``` sedatives diuretics a blockers narcotic alcohol ```
28
changes in the bladder with aging
``` increased urine production at night bladder hyperactivity increases bladder contractility decreases bladder capacity decreases striated sphincter muscle weakens prostate enlarges vaginal atrophy ```
29
physical exam components in the eval of UI
``` mental status, cognition mobility neuro exam -perineal sensation -sphincter tone abdomen -obesity, surgical scars -palpation of bladder ```
30
GU physical exam in men
``` penis -meatus DRE -sphincter tone -stool impaction -prostate size, tenderness, consistency ```
31
GU physical exam in women
pelvic exam - perineal sensation - urethral mobility - vaginal atrophy - prolapse - prior vaginal surgery - cough stress test - rectal exam to assess sphincter tone, stool impaction
32
options for post void residual measurement
measure 10-15 min after urination 1. bladder scanner - can be falsely elevated with ascites present 2. straight cath - invasive, more accurate
33
what is a normal PVR
<50 cc normal | >200 cc too high
34
consider urology referral for UI if....
``` >3 rbc/hpf pelvic organ prolapse recurrent UTI male incontinence severe incontinence neuro disease high PVR behavioral and medical treatment not sufficienct ```
35
urologic workup for UI
urodynamic testing cystoscopy prostate volume
36
behavior treatments for UUI/SUI
``` timed voiding modification of fluid intake avoid bladder irritants (caffeine) bladder retraining (increase time in between voids) pelvic floor exercises +/- biofeedback weight loss quit smoking ```
37
treatment considerations for overflow incontinence
indwelling vs intermittent cath a blocker in males while awaiting urology eval (relax bladder neck) urological eval to determin obstruction vs. underactive detrusor as cause
38
meds for UUI
anticholinergics -nonselective for M3 -selective for M2 B3 agonists
39
mechanism of anticholinergics for UUI
inhibits muscarinic receptors in detrusor to prevent contraction side effects: dry mouth, constipation, dry eyes, urinary retention
40
anticholinergics non selective for M3
``` oxybutynin tolterodine fesoterodine trospium solifenacin ```
41
anticholinergics selective for M3
darifenacin
42
mechanism for B3 agonists for UUI
stimulate B3 receptors in the detrusor to inhibit contraction side effects: HTN, nasopharyngitis, headache, rare urinary retention
43
B3 agonist
mirabegron | can be used in combo with anticholinergics
44
treatment for overflow UI
alpha blockers
45
mechanism of a blockers for overflow UI
relaxation of smooth muscle in prostate, bladder neck | side effects: intraoperative floppy iris syndrome in men undergoing cataract surgery
46
nonselective a blockers
terazosin doxazosin alfuzosin
47
a1 selective a blcokers
tamsulosin | silodosin
48
trasvaginal estrogen in UI
helpful for atrophic vaginitis | low systemic absorption
49
neuromodulation in UUI
sacral nerve stimulation | percutaneous tibial nerve stimulation
50
chemodenervation in UUI
onabotulinum injection into detrusor muscle of bladder
51
surgical options/ vaginal devices for SUI in women
``` vaginal devices -pessary surgical options -urethral bulking agents -midurethral sling -pubovaginal sling ```
52
devices for SUI in men
penile clamp male sling artificial urinary sphincter
53
neurological lesions associated with urinary incontinence
``` cortical -stroke -Parkinsons -MSA suprasacral spinal cord lesions sacral spinal cord lesions -spina bifida -cauda equina peripheral lesions -radial pelvic surgery -diabetes ```
54
cortical lesions
spastic bladder | normal sphincter
55
suprasacral spinal cord lesions
spastic bladder | spastic sphincter
56
sacral spinal cord lesions
flaccid bladder | flaccid sphincter
57
peripheral lesions
spastic/flaccid bladder | normal sphincter
58
what is autonomic dysreflexia
unregulated sympathetic stimulation | occurs primarily in patients with SCI above T6
59
cause of autonomic dysreflexia
noxious stimuli below level of injury | -bladder or bowel distention, UTI, sacral decubitus ulcers
60
symptoms/signs of autonomic dysreflexia
symptoms: headache, flushing, mental status changes signs: hypertension, bradycardia
61
treatment of autonomic dysreflexia
``` can lead to stroke, MI, seizures, pulm edema monitor HR and BP remove noxious stimuli NO paste above level of lesion captopril 25 mg ```
62
types of catheters
indwelling -urethral -suprapubic intermittent
63
implications of catheterization
``` bacteriuria -asymptomatic vs active infection? -pyelonephritis stone formation urethral injury hematuria restricted mobility health care costs ```
64
alternatives to catheterization
absorbant pads condom catheters bladder augmentation urinary diversion

RDS Test 3 (15 decks)

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