Genitourinary #1 Flashcards
Urge incontinence is MC in
older women
What is the pathophysiology of urge incontinence?
Detrusor muscle overactivity: involuntary muscle contractions during bladder filling
What are symptoms of urge incontinence?
Increased urgency, frequency, small volume voids, nocturia. Inability to make it to the bathroom in time.
What is the FIRST line management for urge incontinence?
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
First line MEDICAL therapy for urge incontinence
Antimuscarinics: (Tolterodine, Oxybutynin). These are anticholinergics and antispasmodics that increase bladder capacity
Other medical options for urge incontinence
Mirabegron: beta-3 agonist that causes bladder relaxation
TCA: Imipramine (antispasmodic, increased urethral sphincter tone)
Surgical: Botox injection, bladder augmentation
What is the pathophysiology of overflow incontinence?
Bladder detrusor muscle underactivity (impaired contractility) or bladder outlet obstruction
What are some common etiologies of overflow incontinence?
-Common in neurological disorders or autonomic dysfunction
-DM, MS, spinal injuries, spinal stenosis
-BPH, pelvic organ prolapse
Symptoms of overflow incontinence
-Loss of urine with no warning
-Leakage or dribbling in setting of incomplete bladder emptying
-Hesitancy
-Frequency
-Nocturia
What is the best diagnostic/criteria to diagnose a patient with overflow incontinence?
Post void residual > 200 mL
How to management bladder atony in overflow incontinence (if associated with a neurological disorder)
Intermittent or indwelling catheterization is first-line
-Cholinergics (Bethanechol) increases detrusor muscle activity
If overflow incontinence is due to BPH, what is the treatment?
alpha-blockers for symptom relief
(Terazosin, Tamsulosin, Cardura, Prazosin)
What is stress incontinence?
Involuntary leakage of urine that occurs once increased abdominal pressure > urethral pressure
True or False: stress incontinence is the MC type of incontinence in younger women (45-49 years old)
True
What are some actions that increase abdominal pressure and cause stress incontinence?
Exertion, coughing, laughing, sneezing
What are the two common etiologies of stress incontinence?
Laxity of pelvic floor muscles: childbirth, surgery, postmenopausal estrogen loss
Urethral hyper mobility: insufficient support from pelvic floor musculature
Symptoms of stress incontinence
Urine leakage during times of increased intra-abdominal pressure (coughing, laughing, sneezing, lifting heavy objects)
No urge to urinate prior to leakage
Initial treatment of choice for stress incontinence
Pelvic floor (Kegel) exercises + Lifestyle modifications (weight loss, smoking cessation, protective garment pads, drink smaller amounts of water throughout the day)
What is another option for conservative treatment for stress incontinence
Pessaries
-used if no response to lifestyle modifications and Kegel exercises
What surgical option exists for stress incontinence
Midurethral sling (more rapid and definitive than conservative therapy)
What is peyronie disease?
Abnormal localized fibrotic changes of the tunica albuginea leading to abnormal penile curvature
What layer is fibrotic in peyronie disease?
Tunica albuginea
Symptoms of peyronie disease
-Penile pain
-Curvature
-Induration
-Shortening
-Sexual dysfunction
What is the treatment for peyronie disease if the curvature is less than 30 degrees?
Observation. Urologist referral.
However, if the curvature is greater than 30’ in peyronie disease, what is the treatment?
Oral Pentoxifylline if within 3 months of onset
Intralesional injection with collagenase if > 3 months
What is the MC risk factor for uterine prolapse?
Weakness of pelvic support structures (MC after childbirth)
-Other times: lifting heavy objects, multiple vaginal births, loss of estrogen (post menopause)
Symptoms of uterine prolapse
vaginal fullness
Low back pain, abdominal pain
Symptoms worse with prolonged standing
Urgency, frequency, stress incontinence
Explain the grading scale of uterine prolapse. There are grades 0-4.
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
What are some mechanical treatments for uterine prolapse?
Pessaries elevate and support the uterus. Estrogen treatment may improve atrophy.
However, the surgical management for uterine prolapse includes
Hysterectomy or sacrospinous ligament fixation
What is vesicoureteral reflux?
Retrograde passage of urine from the bladder into the upper urinary tract
What is the MC type of vesicoureteral reflux and why does it occur?
Primary VUR
-Due to inadequate closure of or incompetent ureterovesical junction that contains a segment of the ureter within the bladder wall.
What is often the initial imaging ordered for VUR?
Renal and bladder US
However, the diagnostic imaging of choice for VUR is?
Voiding cystourethrogram (or radionuclide cystogram)
If the VUR presents postnatal, what does it usually look like?
Febrile UTI
Treatment for Grade I and II VUR
Observation and ABX Prophylaxis (Bactrim, Trimethoprim, or Nitrofurantoin)
Treatment for Grade III and IV VUR
Surgical correction is the definitive treatment
