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PANCE 2.0 > Genitourinary #1 > Flashcards

Genitourinary #1 Flashcards

1
Q

Urge incontinence is MC in

A

older women

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2
Q

What is the pathophysiology of urge incontinence?

A

Detrusor muscle overactivity: involuntary muscle contractions during bladder filling

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3
Q

What are symptoms of urge incontinence?

A

Increased urgency, frequency, small volume voids, nocturia. Inability to make it to the bathroom in time.

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4
Q

What is the FIRST line management for urge incontinence?

A

Bladder training: timed frequent voiding, use a voiding diary, decreased fluid intake.
Diet: avoid spicy foods, citrus fruit, chocolate, alcohol, caffeine.
Lifestyle Modifications & Kegel Exercises

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5
Q

First line MEDICAL therapy for urge incontinence

A

Antimuscarinics: (Tolterodine, Oxybutynin). These are anticholinergics and antispasmodics that increase bladder capacity

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6
Q

Other medical options for urge incontinence

A

Mirabegron: beta-3 agonist that causes bladder relaxation

TCA: Imipramine (antispasmodic, increased urethral sphincter tone)

Surgical: Botox injection, bladder augmentation

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7
Q

What is the pathophysiology of overflow incontinence?

A

Bladder detrusor muscle underactivity (impaired contractility) or bladder outlet obstruction

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8
Q

What are some common etiologies of overflow incontinence?

A

-Common in neurological disorders or autonomic dysfunction
-DM, MS, spinal injuries, spinal stenosis

-BPH, pelvic organ prolapse

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9
Q

Symptoms of overflow incontinence

A

-Loss of urine with no warning
-Leakage or dribbling in setting of incomplete bladder emptying
-Hesitancy
-Frequency
-Nocturia

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10
Q

What is the best diagnostic/criteria to diagnose a patient with overflow incontinence?

A

Post void residual > 200 mL

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11
Q

How to management bladder atony in overflow incontinence (if associated with a neurological disorder)

A

Intermittent or indwelling catheterization is first-line
-Cholinergics (Bethanechol) increases detrusor muscle activity

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12
Q

If overflow incontinence is due to BPH, what is the treatment?

A

alpha-blockers for symptom relief
(Terazosin, Tamsulosin, Cardura, Prazosin)

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13
Q

What is stress incontinence?

A

Involuntary leakage of urine that occurs once increased abdominal pressure > urethral pressure

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14
Q

True or False: stress incontinence is the MC type of incontinence in younger women (45-49 years old)

A

True

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15
Q

What are some actions that increase abdominal pressure and cause stress incontinence?

A

Exertion, coughing, laughing, sneezing

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16
Q

What are the two common etiologies of stress incontinence?

A

Laxity of pelvic floor muscles: childbirth, surgery, postmenopausal estrogen loss

Urethral hyper mobility: insufficient support from pelvic floor musculature

17
Q

Symptoms of stress incontinence

A

Urine leakage during times of increased intra-abdominal pressure (coughing, laughing, sneezing, lifting heavy objects)

No urge to urinate prior to leakage

18
Q

Initial treatment of choice for stress incontinence

A

Pelvic floor (Kegel) exercises + Lifestyle modifications (weight loss, smoking cessation, protective garment pads, drink smaller amounts of water throughout the day)

19
Q

What is another option for conservative treatment for stress incontinence

A

Pessaries
-used if no response to lifestyle modifications and Kegel exercises

20
Q

What surgical option exists for stress incontinence

A

Midurethral sling (more rapid and definitive than conservative therapy)

21
Q

What is peyronie disease?

A

Abnormal localized fibrotic changes of the tunica albuginea leading to abnormal penile curvature

22
Q

What layer is fibrotic in peyronie disease?

A

Tunica albuginea

23
Q

Symptoms of peyronie disease

A

-Penile pain
-Curvature
-Induration
-Shortening
-Sexual dysfunction

24
Q

What is the treatment for peyronie disease if the curvature is less than 30 degrees?

A

Observation. Urologist referral.

25
Q

However, if the curvature is greater than 30’ in peyronie disease, what is the treatment?

A

Oral Pentoxifylline if within 3 months of onset
Intralesional injection with collagenase if > 3 months

26
Q

What is the MC risk factor for uterine prolapse?

A

Weakness of pelvic support structures (MC after childbirth)

-Other times: lifting heavy objects, multiple vaginal births, loss of estrogen (post menopause)

27
Q

Symptoms of uterine prolapse

A

vaginal fullness
Low back pain, abdominal pain
Symptoms worse with prolonged standing
Urgency, frequency, stress incontinence

28
Q

Explain the grading scale of uterine prolapse. There are grades 0-4.

A

Grade 0: no descent
Grade 1: uterus descent into upper 2/3 of the vagina
Grade 2: cervix approaches the introitus
Grade 3: cervix outside the introitus
Grade 4: entire uterus is outside the vagina - complete rupture

29
Q

What are some mechanical treatments for uterine prolapse?

A

Pessaries elevate and support the uterus. Estrogen treatment may improve atrophy.

30
Q

However, the surgical management for uterine prolapse includes

A

Hysterectomy or sacrospinous ligament fixation

31
Q

What is vesicoureteral reflux?

A

Retrograde passage of urine from the bladder into the upper urinary tract

32
Q

What is the MC type of vesicoureteral reflux and why does it occur?

A

Primary VUR

-Due to inadequate closure of or incompetent ureterovesical junction that contains a segment of the ureter within the bladder wall.

33
Q

What is often the initial imaging ordered for VUR?

A

Renal and bladder US

34
Q

However, the diagnostic imaging of choice for VUR is?

A

Voiding cystourethrogram (or radionuclide cystogram)

35
Q

If the VUR presents postnatal, what does it usually look like?

A

Febrile UTI

36
Q

Treatment for Grade I and II VUR

A

Observation and ABX Prophylaxis (Bactrim, Trimethoprim, or Nitrofurantoin)

37
Q

Treatment for Grade III and IV VUR

A

Surgical correction is the definitive treatment

PANCE 2.0 (62 decks)

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