Diseases/Malformations of Female Urethra and Bladder Flashcards
Urinary Incontinence Statistics
- Affects >13 million Americans
- 85% affected are women
Types of Bladder Control Problems
- Stress incontinence
- Urinary retention
- Overactive bladder
*urge incontinence
*urgency-frequency
Urinary Incontinence
- 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
Urinary Stress Incontinence
- 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
Signs of Stress Incontinence
Leakage of urine when:
- Laughing
- Coughing
- Lifting
- Exercising
- Increasing abdominal pressure in any other wayd
Most common cause of involuntary loss of urine in woman?
- 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
Causes of Urinary Incontinence
- Urge
- Neurogenic causes
- Ectopic ureteral orifice
- Senile urethritis
- Urethral diverticulum,
- Cystitis, urethritis
- Bladder neoplasm
Types of Urinary Incontinence
- Urge
- Stress
- Mixed
- Transient
- Overflow
Urge Incontinence
- 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
Grading Incontinence
Grade 0- continent
Grade 3- total incontinence (really wet)
Types of Physical Exams for Urinary Incontinence
- 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
Post-void residual indications
- Significant residual may be a sign of a neurogenic bladder dysfunction or possible cystocele
Cystometrogram
- 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
Normal Cystometrogram Study
- 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
Marshall Test
- 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
Cytoscopy
- Evaluation of the bladder mucosa and ureteric orifices w/ a scope
- R/O bladder pathology
*neoplasm
*diverticulum
*calculi`
Urge Incontinence Treatment
- Treat underlying condition
- Anticholinergics (oxybutynin, tolteridine)
- Behavior modification
- Electrical stimulation, biofeedback
- Botox
Anticholinergics for Urge Incontinence
- Oxybutynin
- Tolteridine
Factors that accentuate stress urinary incontinence
- Obesity
- Chronic pulmonary problems
- Recurrent UTI’s
- W/ correction of the above factors, SUI may be successfully treated in milde cases
Treatment of urinary stress incontinence
- Correct factors that contribute
- Kegal exercises
- Pharmacologic therapy
- Minimally invasive procedures
- Surgery
Pessaries
- 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
Pharmacologic Treatments for Stress Incontinence
- Anticholinergics
- Sympathomimetic agents
- Tricyclic antidepressants
- Duloxetine (block serotonin and norepinephrine reuptake)
Minimally invasive Procedures for Urinary Incontinence
- Peri-urethral bulking agents; collagen, durasphere
Surgical Treatement for Stress Urinary Incontinence
- 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
