female urinary incontinence

Question 1

What structure is responsible for continenc

Answer 1

The intrinsic sphincter, comprised of bladder neck muscle fibers and the mid-urethral complex(smooth muscle)

Question 2

know the locations of the following: bladder neck sphincter, mid-urethra complex, external rhabdosphincter, detrusor muscle,

Answer 2

ok

Question 3

what structures make up the external urethral sphincter

Answer 3

rhabdosphincter plus the striated muscle surrounding the urethra

Question 4

Which structures support the bladder neck and urethra

Answer 4

the arcus tendinous fasciae pelvis, the levator ani muscles, and the endopelvic fascia

Question 5

peripheral innervation of lower urinary tract

Answer 5

the sacral parasympathetic (pelvic nerve); the thoracolumbar sympathetic (hypogastric nerve); and the sacral somatic (pudendal nerve)

Question 6

mechanism of urine storage phase

Answer 6

bladder fills > beta-adrenergic receptors in bladder send message via PSNS (pelvic nerve) to sacral spinal cord > pudendal nerve signals external urethral sphincter to constrict > hypogastric nerve signals detrusor to relax and expand, and internal urethral sphincter to constrict.

Question 7

Guarding reflex

Answer 7

As the bladder fills, the external urethral sphincter increases its contractions in an action known as the guarding reflex. This also prevents urine loss during coughing, sneezing, etc.

Question 8

mechanism of urine emptying phase

Answer 8

Pelvic nerve sends message to sacral spinal cord > pontine micturition center > cerebral cortex (voluntary control center) > sends signal to hypogastric nerve to cause detrusor muscle contraction and sends signal to pudendal nerve to cause levator ani relaxation, internal and external sphincter opening

Question 9

which neurotransmitters are involved in storage and emptying phases of urination?

Answer 9

Urethral smooth muscle has alpha-adrenergic receptors and detrusor muscle has beta adrenergic receptors plus muscarinic receptors. Storage: norepinephrine and serotonin cause detrusor relaxation and urethral contraction. Emptying: acetylcholine released causes detrusor contraction

Question 10

1. List and define the categories of urinary incontinence.

Answer 10

1. stress incontinence: the complaint of involuntary leakage on effort or exertion, or on sneezing or coughing. 2. Urge incontinence: the complaint of involuntary leakage accompanied by or immediately preceded by urgency. 3. Mixed incontinence: of involuntary leakage associated with urgency and also with exertion, effort, sneezing or coughing. 4. overflow incontinence: urinary retention from hypotonic bladder. 5. Genitourinary fistulase

Question 11

Subcategories of stress incontinence

Answer 11

type 1: urine loss occuring in absence of urethral hypermobility. Type 2: urine loss due to urethral hypermobility. Type 3: urine loss due to intrinsic sphincter deficiency

Question 12

What causes urge incontinence

Answer 12

Sudden, involuntary bladder contractions. Most are idiopathic (idiopathic detrusor overactivity) but some have identifiable causes like inflammation, infection, parkinsons (neurogenic), myogenic

Question 13

stress incontinence pathophys

Answer 13

Urethral hypermobility and/or intrinsic sphincter deficiency

Question 14

urge incontinence Sx

Answer 14

urgency (with or without incontinence), frequency (defined as the patient complaint of voiding too often during the day), and nocturnal enuresis (defined as awakening 1 or more times at night to void) and dysuria. More than one symptom must be present

Question 15

methods to evaluate urinary incontinence

Answer 15

1. cystometry: detects rises in bladder pressure and the sensations that occur when the bladder fills. Low sensitivity but improves reliability of cough stress test due to a known bladder volume. 2. cough stress test. 3. multichannel urodynamics: Pressure catheter in bladder and vagina or rectum
2. cystometry: detects rises in bladder pressure and the sensations that occur when the bladder fills. Low sensitivity but improves reliability of cough stress test due to a known bladder volume. 2. cough stress test. 3. multichannel urodynamics: Pressure catheter in bladder and vagina or rectum

Question 16

levator ani functions

Answer 16

contain 70% type I (slow-twitch) fibers to maintain constant tone and30% type II (fast-twitch) fibers to provide reflex and voluntary contractions.

Question 17

maximum capacity of the bladder, volume of first sensation of bladder fullness, volume at desire to void

Answer 17

max capacity: 500ml. First sensation: 100cc. Desire to void: 250ml

Question 18

What is the mainstay of medical treatment for ovaractive bladder

Answer 18

Anticholinergic drugs

Question 19

how to anticholinergic drugs work in OAB

Answer 19

muscarinic receptors M2 and M3 predominate in the bladder, with M3 responsible for contraction. Blocking these receptors reduces activity of bladder

Question 20

Anticholinergic side effects

Answer 20

Memory loss (M1 block), tachycardia (M2 block), constipation (M3 block), dry mouth, blurred vision and drowsiness (all M3 block)

Question 21

List antispasmodics used for OAB

Answer 21

oxybutynin: smooth muscle relaxant. Tolterodine: muscarinic antagonist. Trospium: antimuscarinic

Question 22

alpha and beta adrenergic innervation of the bladder/urethra

Answer 22

alpha adrenergic stimulation contracts the bladder neck and urethra and relaxes the detrusor. beta-Adrenergic stimulation relaxes the urethra and detrusor muscle

Question 23

list other medical treatments for urinary incontinence

Answer 23

estrogens (used if urethral atrophy is the problem), tricyclic antidepressants (anticholinergic properties improve compliance and increases bladder outlet resistance)