Bladder Disorders (Exam 3) Flashcards
The loss of urine that represents a hygienic or social problem to individual
Involuntary Urine Incontinence
causation of Urinary incontinence
Multifactorial - Etiologies are diverse and not completely understood
Urinary incontinence is _____ times more likely in this sex
2 X more likely
Females
Largest single Risk Factor of Urinary Incontinence
Age
Higher prevalence in ?
Non-Hispanic White Women
What percentage of incontinent individuals actually receive the appropriate medical evaluation / TX
5%
Average time a pt will live with urinary incontinence prior to seeking medical attention
6-9 years
Pneumonic to remember Reversible causes of Urinary Incontinence
Dippers
Dippers stands for what?
Delirium infection atrophic pharmaceutical psychological disorders excess restricted mobility
An increased intra-Abdominal Pressure raises pressure within bladder to the point where it exceeds the Urethra’s Resistance to urinary flow is
Stress Incontinence
what causes the urethral hypermobility
due to impaired support from pelvic floor
Intrinsic Sphincter Deficiency is usually secondary to what
Pelvic Surgeries
Presentation of Stress Incontinence
Coughing, Laughing, and Sneezing
worsens during high-impact sports such as golf, tennis, aerobics, trampolines
A lot or Little urine is lost during Stress incontinence
Little
what is Urge Incontinence
The involuntary loss of urine associated with a feeling of urgency
what is the main cause of urge incontinence
Detrusor Overactivity
Presentation of Urge Incontinence
Uncontrolled urine loss and a strong desire to void. Often sudden and rapid event. occurs without warning. Cannot be prevented
Combination of stress and urge incontinence is
Mixed incontinence
40-60% of females with incontinence have combination
Mixed incontinence is generally defined as
Detrusor Overactivity and Impaired Urethral Function
True or false - the detrusor muscle contraction is involved with overflow incontinence
False- The pressure exceeds the resting urethral closure pressure and urine overflows despite the absence of detrusor contraction
Overflow Incontinence is often secondary to
Bladder Outlet Obstruction
Common Associated Medical conditions to Overflow Incontinence
MS
Diabetes
Overflow incontinence has the pt urinating a large or small amount
Small
DDX of a pt with urinary incontinence
MS Prostatitis vaginitis UTI Spinal Cord Neoplasm/trauma /abscess Cystitis Urinary Obstruction
What needs to be including in a PE for Urinary Incontinence
Neurologic exam Pelvic Exam Pelvic Floor Examination anal muscle tone Prostate examination Stress testing
procedure to look into bladder can be diagnostic and treatment in some cases
Cystoscopy / Urethroscopy
when is cystoscopy utilized
- pt with persistent irritative voiding symptoms
- Hematuria
- Persistent postoperative incontinence
- Voiding dysfunction
- obvious causes of bladder overactivity, such as cystitis , stone, and tumor
Management techniques for urinary incontinence
Absorbent products Dietary Modification Pelvic Floor Rehabilitation Biofeedback Acupuncture Electrical Stimulation Urethral Occlusion Catheterization Bladder Training Pharmacologic therapy
Which incontinence is it contraindicated to use catheterization as a management technique
Urge Incontinence
which incontinence is bladder training known to have decent success
Urge Incontinence
When is it contraindicated to utilize Anticholinergics as pharmacologic therapy in incontinence management
Narrow / Angle glaucoma
Pharmacologic treatment options for incontinence
Anticholinergics, Antispasmodic agents, and Tricyclic Antidepressants
Surgical Tx options for incontinence
Bladder Neck Suspension
Periurethral Bulking Therapy
Artificial urinary sphincter placement
Midurethral sling surgery
Daytime and Nighttime urinary frequency, urgency, and pelvic pain of unknown etiology
Interstitial Cystitis
How do we make the diagnosis of Interstitial Cystitis
Diagnosis of Exclusion
what percentage of Interstitial cystitis are white
What percentage are female
94%
90%
What is the term dedicated to sex-related distress / pain with sex
Dyspareunia
Presentation of Interstitial cystitis
Exacerbation followed by variable periods of remission
May fluctuate to the ovulatory cycle
spontaneous remission occurs in 50%
Pain with bladder filling common
What are the scorings for possible interstitial cystitis and strongly supported diagnosis of interstitial cystitis
Sore > 6
Score > 12
Diagnostic Evaluation of Interstitial cystitis includes what
UA
Urine Culture
Cystoscopy
During Cystoscopy What are the two distinctive findings to help associate problems with interstitial Cystitis
Hunter’s Lesions - Distinctive areas of inflammation on the bladder wall 5-10% of pts willl have this
Glomerulations- Pinpoint sized areas of bleeding in the bladder wall
Tx of Interstitial Cystitis
Extensive counseling
3-6 month trial of Dietary and fluid management Time and stress management, and behavioral modification
-up to 90% of pts report exacerbations with food / beverage
Foods that are good for Interstitial cystitis
Water, milk, bananas, blueberries, melon, carrots, broccoli, mushrooms, peas, chicken, eggs, most meats, rice, popcorn
Foods that will aggravate Interstitial Cystitis
Coffee, Alcohol, soda, monosodium glutamate (MSG), Tomatoes, vinigar, citrus, spicy foods, chocolate, cranberry juice, particular fruits and vegetables
Oral meds for Tx of Interstitial Cystitis
Amitriptyline (first-line oral therapy)
Nifedipine
Pentosan polysulfate sodium
Bladder hydrodistention
Good 2nd line therapy added for Interstitial cystitis
Physical therapy
Define Nocturnal Enuresis
Voiding urine at night “bedwetting”
How many months must a pt have been continent for before it can be considered Nocturnal Enuresis
6 months at minimum prior to onset of bedwetting
Punishment is or is not an effective form of nocturnal enuresis
not an acceptable or effective from. Children punished are at a risk of emotional and physical abuse.
genetics link to nocturnal enuresis
56% of fathers 36% of mothers and 40% of siblings to pts with nocturnal enuresis also experience nocturnal enuresis
Physical Examination of Nocturnal Enuresis includes
BP
Inspection of external Genitalia
Palpation in renal and suprapubic areas
palpation of the abdomen to look for hard, wide stool
Thorough neurologic examination of LE’s including gait, muscle power, tone, sensation, reflexes, and plantar responses
Assessment of the anal wink
inspection and palpation of the lumbosacral spine
Diagnosis needs for nocturnal enuresis
UA
Urine Culture
Diagnostic imaging not routinely recommended
Management nocturnal enuresis
Behavioral Therapy
Alarm Therapy
medications
Refer nocturnal enuresis when
If no improvement after 2-3 months of good management / treatment
pharmacologically decreases urine output
Desmopressin
Take Desmopressin when
1 hr before bedtime
Take imipramine when
1-2 hrs before bedtime
Male to female ratio of bladder tumors
1.9 : 1
incredibly large exposure causing bladder cancer
Smoking
most common presenting symptom of Bladder tumors
Hematuria
are bladder tumors typically benign or malignant
Benign
bladder cancer is how many more times likely in which sex
3x more likely in Men
Median age of diagnosis of bladder cancer
65 y.o.
Transitional cell carcinoma is what percentage of bladder cancers
90%
percentage of pts that have painless gross hematuria
80-90 %
