Bladder Disorders Flashcards
What part of the brain is responsible for urination?
Afferent activity stim pontine micturation center to initiate voluntary void
What is the effect of PNS stimulation of bladder?
Bladder outlet and sphincter relaxation
Coordinated contraction of bladder smooth muscle
What is urinary incontinence?
Invol loss of urine
Bladder/sphincter dysfunction or both
What are the types of Bladder dysfunction?
Urge incontinence
-detrusor overactivity
-poor detrusorcompliance
Overflow incontinence
What are the types of Outlet dysfunction?
Anatomic Stress incontinence
Intrinsic Sphincter Deficiency
What are the Potentially reversible transient causes of Urinary incontinence?
DIAPERS Delirium/Cog impairment Infection Atrophic Vaginitis/urethritis Pharm/meds Excessive urine output Restricted mobility Stool impaction
What types of meds Cause transient Urinary incontinence?
Sedatives Diuretics Anticholinergics Alpha-Adr Alpha-Ant
What is included in an Incontinence Evaluation?
Urinalysis Urine Culture Post void residual volume measurement Voiding Diary Pelvic exam for urethral hypermobility/prolapse Urodynamics Cystoscopy
What constitutes Overactive Bladder?
Frequency and urgency w/without urge incontinence
What constitutes Urge Urinary Incontinence
Involuntary Urine Leak w/ strong sudden desire to urinate
Bladder pressure overcomes sphincter mechanism
What constitutes Detrusor Overactivity?
Intermittent involuntary bladder contractions
Idiopathic or neurogenic
What constitutes Poor Compliance of Bladder?
Incremental rise in pressure as bladder vol increases
Loss of viscoelastic properties or disrupt of neuro reg
How do Anticholinergics help with incontinence?
UUI/OAB
Inhibits invol. detrusor muscle cont. by blocking muscarinic receptors
What are SE and Contraindications of Antichol?
SE: Dry mouth, Constipation, urinary retention, nausea, blurred vision, drowsiness, Confusion
ContIn: Narrow angle Glaucoma
How do Beta 3 Antagonists help with incontinence?
Inhibits involuntary detrusor muscle contraction by activating B3 receptors
What are the surgeries that treat OAB/Urge incont?
Sacral Nerve mod
Intravesical Botox injection
Bladder aug or Diversion
What are causes of overflow incontinence?
Extreme bladder volumes
Bladder outlet obstruction or poor detrusor contractility
Meds
Constipation
Pelvic Prolapse, prostate, urethral stricture
Pelvic Surgery
Sphincter dysfunct
What is Stress urinary incontinence?
Invol urine leak with sudden inc in abdominal pressure
MEN: postsurgical
Women: pelvic floor muscles and sphincter tone
What is the difference between True anatomic stress incontinence and intrinsic sphincter Def?
Urethral Hypermobility or urethra below pelvic floor
Weakness of sphincter
More severe
What are indications for urology Referral?
Failure to respond to conservative therapy
Hematuria
Recurrent infections
Complicated incontinence
What are the different types of UTI?
Uncomplicated- healthy Pt
Complicated
Recurrent- occurs after resolution
Reinfection- new event with reintro of bacteria into GU tract
Persistent- Same bacteria from focus of inf
What are the causes of Complicated UTI?
Inc risk and dec efficacy of therapy
Abnormal GU tract
Immunocompromised host
Multi drug resistant Bacteria
What are the Risk factors for UTIs?
Poor fluid intake/dehyd Infrequent Void Incomp bladder emptying Constipation Vaginal Atrophy Staghorn Calculi Urinary cath Abn urinay tract Underlying dis Poorhygeine Sexual activity
What are the urine studies done in UTI?
Urine Collection UA- leukocyte est -nitrite -Blood, goss or micro -10 WBCs/HPF Urine culture
What is the Tx of UTI?
Empiric Abtx: Sulfamethoxazole/ Trimethoprim or fluoroquinolones
Adjust based on sensitivity
Mod Risk factors
Low dose prophylaxis if recurrent
What are the disorders associated with Cystitis?
Fibromyalgia IBS Endometriosis Vulvodynia Multiple allergies
What is on the DDx of Cystitis?
Recurrent UTI Endometriosis Pelvic Mass OAB or neurogenic Bladder Bladder Cancer
What is the Suggested Etiology of Cystitis?
Inc mast Cell Conc in bladder => releases histamine
Def in GAG layer in Urothelium
Neurogenic Hypersense at level of bladder or sacral spinal cord
Pelvic Floor dysfunction
AI disorder
Atypical Inf agents
Bladder wll scarring and fibrosis
