genitourinary Flashcards
loss of urine associated with activities that increase intraabdominal pressure
stress incontinence
Involuntary loss of urine usually preceded by a strong, unexpected urge to void
Urge incontinence
Urge and stress incontinence together
mixed incontinence
an involuntary loss of urine associated with incomplete emptying
overflow incontinence
function of bladder volume
Overactive bladder
effects urine flow in men
prostate, or BPH
hypermobility of the bladder neck bladder is competent at rest, increase in abdominal pressure leads to increased closure pressure
anatomic stress urinary incontinence-
Open bladder neck at rest, mild increase in intra abdominal pressure can result in leakage
Intrinsic sphincter deficiency
instability of the detrusor muscle during bladder filling due to idiopathic or neurogenic causes. Causes the bladder neck to open and incontinence to occur
detrusor overactivity
incontinence related to spinal cord injuries below t11 or l1, may be caused by MS, SM or spina bifida
neurogenic bladder
Resnick’s DIAPPERS mnemonic
Delirium or confused state Infection- urinary Atrophic urethritis, vaginitis Pharmaceuticals Psychological, especially severe depression Excess urinary output (CHF, hyperglycemia) Restricted mobility Stool impaction
systems involved in physical examination for incontinence
Abdominal, genitourinary, pelvic, and rectal components
Management of stress incontinence
Behavioral therapies include…
Behavioral therapies: timed or double voiding, smoking cessation, weight loss, pelvic muscle exercises pessary, bowel management
Management of stress incontinence
Medical therapies include…
Alpha-adrenergic agonists: methoxamine, phenylephrine, oxymetazoline, tetrahydrozoline, xylometazoline
Tricyclic antidepressants: Remeron (mirtazipine),
estrogen
what do alpha-adrenergic agonists do
bind a alpha receptors on vascular smooth muscle and induce smooth contraction and vasoconstriction. Mimics sympathetic adrenergic nerve activation
how do tetracyclic antidepressants work
act by inhibiting reuptake of neurotransmitters serotonin and or noradrenaline in the brain thus elevating mood. Used less due to side effects
managing stress incontinence
Surgical therapies include:
Bladder neck suspensions, slings, artificial sphincters
Urge incontinence
behavioral therapie…
bladder training, schedule voiding, minimize bladder irritants, suppression of urge
Urge incontinence
Medical management:
anticholinergic- antimuscarinics, vaginal estrogen
how do anticholinergics work
blocking acetylcholine prevents impulses from the parasympathetic nervous system from reaching smooth muscle and causing contractions, cramps or spasms
anticholinergic medications
dicyclomine, chlordiazepoxide, atropine, scopolamine, glycopyrrolate
how do antimuscarinic medications work
inhibiti the functions of parasympathetic nervous system : atropine scopolamine
urge incontinence management
surgical therapies
neurosacral modulation, bladder augmentation, botox injections
Health promotion to reduce incontinence
Weight management, tobacco cessation, exercise. food and fluid adjustments
