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RGU Exam 3 > Diseases/Malformations of Female Urethra and Bladder > Flashcards

Diseases/Malformations of Female Urethra and Bladder Flashcards

1
Q

Urinary Incontinence Statistics

A
  • Affects >13 million Americans
  • 85% affected are women
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2
Q

Types of Bladder Control Problems

A
  • Stress incontinence
  • Urinary retention
  • Overactive bladder

*urge incontinence

*urgency-frequency

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3
Q

Urinary Incontinence

A
  • Loss of voluntary control over your urinary functions
  • May consist of the loss of a few drops while coughing/laughing to sudden urge to urinate
  • Major problem for elderly
  • Predisposes to perineal rashes, pressure ulcers, UTI’s, urosepsis, falls and fractures
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4
Q

Urinary Stress Incontinence

A
  • The involuntary loss of urine thru an intact urethra which is caused by an
  • Increase in intra-abdominal pressure and
  • Is of sufficient quantity to be socially embarrassing
  • The visual demonstration of a simultaneous loss of urine w/ the rise and fall of abdominal pressure during coughing is absolutely necessary for eventual successful surgical correction of urinary stress incontinence
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5
Q

Signs of Stress Incontinence

A

Leakage of urine when:

  • Laughing
  • Coughing
  • Lifting
  • Exercising
  • Increasing abdominal pressure in any other wayd
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6
Q

Most common cause of involuntary loss of urine in woman?

A
  • Urinary stress incontinence
  • B/w 40-50% of young health women admit to occasional mild stress urinary incontinence
  • At least 80% of stress urinary incontinence pts are multiparous and in the peri-menopausal age group
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7
Q

Causes of Urinary Incontinence

A
  • Urge
  • Neurogenic causes
  • Ectopic ureteral orifice
  • Senile urethritis
  • Urethral diverticulum,
  • Cystitis, urethritis
  • Bladder neoplasm
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8
Q

Types of Urinary Incontinence

A
  • Urge
  • Stress
  • Mixed
  • Transient
  • Overflow
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9
Q

Urge Incontinence

A
  • Pts. w/ pure urege incontinence cannot be cured by surgery
  • Loss of urine occurs following the sensation and desire to void
  • 1/3 of pts. w/ surgically curable stress urinary incontinence have urgency on initial presentation
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10
Q

Grading Incontinence

A

Grade 0- continent

Grade 3- total incontinence (really wet)

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11
Q

Types of Physical Exams for Urinary Incontinence

A
  • Abdominal rectal and pelvic exam
  • Post-void residual

*scan of bladder after urination

  • Cystometrogram

*infuse water into the bladder and time how long until urge to urinate; determine how well they store and empty

  • Marshall or Q tip test

*place a Q tip at urethra after filling bladder w/ water and have pt. cough

  • Cystoscopy

*looking at the lining of the bladder w/ a scope

Additional studies

  • Complete urodynamics
  • Leak-point pressure
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12
Q

Post-void residual indications

A
  • Significant residual may be a sign of a neurogenic bladder dysfunction or possible cystocele
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13
Q

Cystometrogram

A
  • Evaluate bladder’s storage and emptying capacity
  • Differentiate stress from urge incontinence
  • Rule-out neurogenic dysfunction

*detrussor hyperflexia

*overactive bladder

*atonic bladder

*sphincter-detrussor dysynergia

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14
Q

Normal Cystometrogram Study

A
  • 1st sensation at 150-200 cc
  • 2nd sensation and urge to void at 350 cc
  • Normal bladder capacity 400-500 cc
  • In the erect position, the normal bladder neck is cough and strain proof
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15
Q

Marshall Test

A
  • Lithotomy and erect position
  • Positive- loss of urine in either or both positions
  • Surgically curable

*if elevation of the vesical neck while pt. coughs prevents urine loss

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16
Q

Cytoscopy

A
  • Evaluation of the bladder mucosa and ureteric orifices w/ a scope
  • R/O bladder pathology

*neoplasm

*diverticulum

*calculi`

17
Q

Urge Incontinence Treatment

A
  • Treat underlying condition
  • Anticholinergics (oxybutynin, tolteridine)
  • Behavior modification
  • Electrical stimulation, biofeedback
  • Botox
18
Q

Anticholinergics for Urge Incontinence

A
  • Oxybutynin
  • Tolteridine
19
Q

Factors that accentuate stress urinary incontinence

A
  • Obesity
  • Chronic pulmonary problems
  • Recurrent UTI’s
  • W/ correction of the above factors, SUI may be successfully treated in milde cases
20
Q

Treatment of urinary stress incontinence

A
  • Correct factors that contribute
  • Kegal exercises
  • Pharmacologic therapy
  • Minimally invasive procedures
  • Surgery
21
Q

Pessaries

A
  • A device placed into the vagina which elevates the urethrovesical (urethra/bladder) angle; pushes everything back
  • Used for urinary incontinence
  • Not always aesthetically pleasing
  • May be useful in debilitated elderly pts. who aren’t candidates for surgery
22
Q

Pharmacologic Treatments for Stress Incontinence

A
  • Anticholinergics
  • Sympathomimetic agents
  • Tricyclic antidepressants
  • Duloxetine (block serotonin and norepinephrine reuptake)
23
Q

Minimally invasive Procedures for Urinary Incontinence

A
  • Peri-urethral bulking agents; collagen, durasphere
24
Q

Surgical Treatement for Stress Urinary Incontinence

A
  • Purpose is to elevate the bladder neck to a position behind the symphysis pubis
  • Surgery corrects stress incontinence by supporting the bladder neck and urethra in their natural position
  • Transvaginal
  • Retropubic
  • Combination of above
  • Pubovaginal sling
  • Artificial sphincter
25
Q

Pelvic Organ Prolapse

A
  • When the vaginal wall becomes too weak to hold the bladder, uterus, vaginal wall or rectum in place
26
Q

Kegel Exercises for Urinary Incontinence

A
  • Improves mild stress incontinence
  • Must be highly motivated w/ strong pubococcygeus muscles and few anatomic abnormalities
27
Q

Pubovaginal Sling

A
  • Sling is placed under urethra forming a cradle to provide support
  • Can return to regular activity 2-3wks
  • Avoid heavy lifting, intercourse and any abdominal pressure for 6-8wks
  • May require antibiotic
  • Overnight hospital stay may be required
28
Q

InterStim Therapy for Urinary Control

A
  • FDA approved treatment for urinary control problems in people who have not had success w/ or could not tolerate more conventional treatments
  • A small stimulation system is implanted under the skin, usually in your upper buttock
  • The device provides electrical stimulation of the sacral nerves to help restore more normal voiding function
  • This therapy is reversible at any time
29
Q

Benign Urethral Lesions

A
  • Urethral caruncle
  • Cysts
  • Condyloma accuminata (viral warts)
30
Q

Condyloma Accuminata Treatment

A
  • Topical chemotherapeutic agents (podophylin, aldara, condylox)
  • Electrocautery
  • Cryo
  • Laser

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