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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
Q

risk factors for UI

A 
gender (2x more in women)
age (younger = stress, older=urge)
pregnancy (stress in 40%)
parity
smoking
obesity
diabetic neuropathy
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26
Q

reversible causes of UI

A 
delirium, dementia
infection
atrophic vaginitis
psychosocial: depression
pharma
endocrine disorders
restricted mobility
stool impaction
27
Q

drugs that can cause UI

A 
sedatives
diuretics
a blockers
narcotic
alcohol
28
Q

changes in the bladder with aging

A 
increased urine production at night
bladder hyperactivity increases
bladder contractility decreases
bladder capacity decreases
striated sphincter muscle weakens
prostate enlarges
vaginal atrophy
29
Q

physical exam components in the eval of UI

A 
mental status, cognition
mobility
neuro exam
-perineal sensation
-sphincter tone
abdomen
-obesity, surgical scars
-palpation of bladder
30
Q

GU physical exam in men

A 
penis
-meatus
DRE
-sphincter tone
-stool impaction
-prostate size, tenderness, consistency
31
Q

GU physical exam in women

A

pelvic exam

  • perineal sensation
  • urethral mobility
  • vaginal atrophy
  • prolapse
  • prior vaginal surgery
  • cough stress test
  • rectal exam to assess sphincter tone, stool impaction
32
Q

options for post void residual measurement

A

measure 10-15 min after urination

  1. bladder scanner
    - can be falsely elevated with ascites present
  2. straight cath
    - invasive, more accurate
33
Q

what is a normal PVR

A

<50 cc normal

>200 cc too high

34
Q

consider urology referral for UI if….

A 
>3 rbc/hpf
pelvic organ prolapse
recurrent UTI
male incontinence
severe incontinence
neuro disease
high PVR
behavioral and medical treatment not sufficienct
35
Q

urologic workup for UI

A

urodynamic testing
cystoscopy
prostate volume

36
Q

behavior treatments for UUI/SUI

A 
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
Q

treatment considerations for overflow incontinence

A

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
Q

meds for UUI

A

anticholinergics
-nonselective for M3
-selective for M2
B3 agonists

39
Q

mechanism of anticholinergics for UUI

A

inhibits muscarinic receptors in detrusor to prevent contraction
side effects: dry mouth, constipation, dry eyes, urinary retention

40
Q

anticholinergics non selective for M3

A 
oxybutynin
tolterodine
fesoterodine
trospium
solifenacin
41
Q

anticholinergics selective for M3

A

darifenacin

42
Q

mechanism for B3 agonists for UUI

A

stimulate B3 receptors in the detrusor to inhibit contraction
side effects: HTN, nasopharyngitis, headache, rare urinary retention

43
Q

B3 agonist

A

mirabegron

can be used in combo with anticholinergics

44
Q

treatment for overflow UI

A

alpha blockers

45
Q

mechanism of a blockers for overflow UI

A

relaxation of smooth muscle in prostate, bladder neck

side effects: intraoperative floppy iris syndrome in men undergoing cataract surgery

46
Q

nonselective a blockers

A

terazosin
doxazosin
alfuzosin

47
Q

a1 selective a blcokers

A

tamsulosin

silodosin

48
Q

trasvaginal estrogen in UI

A

helpful for atrophic vaginitis

low systemic absorption

49
Q

neuromodulation in UUI

A

sacral nerve stimulation

percutaneous tibial nerve stimulation

50
Q

chemodenervation in UUI

A

onabotulinum injection into detrusor muscle of bladder

51
Q

surgical options/ vaginal devices for SUI in women

A 
vaginal devices
-pessary
surgical options
-urethral bulking agents
-midurethral sling
-pubovaginal sling
52
Q

devices for SUI in men

A

penile clamp
male sling
artificial urinary sphincter

53
Q

neurological lesions associated with urinary incontinence

A 
cortical
-stroke
-Parkinsons
-MSA
suprasacral spinal cord lesions
sacral spinal cord lesions
-spina bifida
-cauda equina
peripheral lesions
-radial pelvic surgery
-diabetes
54
Q

cortical lesions

A

spastic bladder

normal sphincter

55
Q

suprasacral spinal cord lesions

A

spastic bladder

spastic sphincter

56
Q

sacral spinal cord lesions

A

flaccid bladder

flaccid sphincter

57
Q

peripheral lesions

A

spastic/flaccid bladder

normal sphincter

58
Q

what is autonomic dysreflexia

A

unregulated sympathetic stimulation

occurs primarily in patients with SCI above T6

59
Q

cause of autonomic dysreflexia

A

noxious stimuli below level of injury

-bladder or bowel distention, UTI, sacral decubitus ulcers

60
Q

symptoms/signs of autonomic dysreflexia

A

symptoms: headache, flushing, mental status changes
signs: hypertension, bradycardia

61
Q

treatment of autonomic dysreflexia

A 
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
Q

types of catheters

A

indwelling
-urethral
-suprapubic
intermittent

63
Q

implications of catheterization

A 
bacteriuria
-asymptomatic vs active infection?
-pyelonephritis
stone formation
urethral injury
hematuria
restricted mobility
health care costs
64
Q

alternatives to catheterization

A

absorbant pads
condom catheters
bladder augmentation
urinary diversion

RDS Test 3 (15 decks)

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