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SUMGERI > GERI-Urinary > Flashcards

GERI-Urinary Flashcards

1
Q

How does prevalence of urinary incontinence change as one ages within the sexes?

A

Prevalence increases with age. Affects women more than men (2:1) until age 80, when it affects men and women equally.

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2
Q

What complications can occur with urinary incontinence?

A
  • Cellulitis, pressure ulcers - UTIs - Sleep deprivation, falls with fractures - Sexual dysfunction - Depression, social withdrawal - Impaired quality of life
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3
Q

In order to be continent of urine, what abilities must one have?

A

Mobility, manual dexterity, cognitive ability to recognize and react to bladder sensation, motivation to stay dry, absence of medical conditions that affect the bladder and general function, and balance and coordination of bladder smooth muscle/urethral sphincter mechanisms.

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4
Q

What nerves activate the bladder smooth muscle (destructor muscle) aka urine storage?

A

Parasympathetic nerves (S2-S4)

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5
Q

What nerves control the urethral sphincter aka voiding?

A

Sympathetic nerves! - Proximal urethral smooth muscle via T11-L2 - Distal urethral striated muscle via S2-S4

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6
Q

In women, what structure helps to support normal micturition when abdominal pressure increases (i.e. in pregnancy)?

A

The musculofascia

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7
Q

What portions of the CNS are involved in normal micturition? (3)

A
  • Parietal lobes and thalamus receive and coordinate destructor afferent stimuli. - Frontal lobes and basal ganglia provide signals to inhibit voiding. - Pontine micturition center integrates these inputs and coordinates urethral and detrusor function.
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8
Q

What medical condition often leads to incontinence in men?

A

BPH

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9
Q

What age-related change often leads to incontinence in women?

A

Atrophic vaginitis and urethritis

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10
Q

What are the clinical types of urinary incontinence?

A
  1. Urge 2. Stress 3. Mixed 4. Overflow A. Outlet obstruction B. Detrusor underactivity
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11
Q

What is the most common type of urinary incontinence?

A

Urge incontinence.

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12
Q

What are the signs and symptoms of urge incontinence?

A
  • Abrupt urgency - Frequency - Nocturia - Volume of leakage may be large or small.
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13
Q

What is the cause of urge incontinence?

A

Detrusor hyperactivity that can be idiopathic, age-related, or secondary to a CNS lesion, local bladder irritation, or stress related.

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14
Q

How do you test if someone has urge incontinence?

A

stress maneuver-coughand see if incontinence occurs.

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15
Q

What is the cause of stress incontinence?

A

Sphincter failure —> does not close all the way and leads to leakage.

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16
Q

How can you test for stress incontinence?

A

Also with a stress maneuver —> if there is a several second delay before leakage, suggests stress-induced detrusor overactivity.

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17
Q

What is mixed urinary incontinence?

A

Stress and urge incontinence symptoms combined.

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18
Q

What are the 2 causes of urethral sphincter failure with stress incontinence?

A
  1. Impaired pelvic supports 2. Failure of urethral closure- trauma or scarring from surgery).
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19
Q

What are the symptoms of overflow incontinence?

A
  • Dribbling - Weak urinary stream - Intermittency - Hesitancy - Frequency - Nocturia
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20
Q

What is the cause of overflow incontinence?

A

Detrusor underactivity, bladder outlet obstruction, or both.

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21
Q

Are most men with an outlet obstruction (i.e. BPH) incontinent?

A

NO! Most men have difficulty urinating, rather than incontinence.

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22
Q

What are the 3 types of outlet obstruction in men?

A
  • BPH - Prostate CA - Urethral stricture
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23
Q

What are the potential causes of outlet obstruction in women? Is this common?

A

Usually due to previous anti-UI surgery or large cystocele. NOT common.

24
Q

What is the most common cause of urinary incontinence in the elderly?

A

Detrusor underactivity- PSNS no working

25
Q

How does detrusor underactivity occur?

A
  • Replacement of detrusor smooth muscle by fibrosis and connective tissue - Neurologic causes - Damage to spinal detrusor efferent-disc herniation, spinal stenosis, tumor.
26
Q

What portions of the physical exam should be done when assessing a patient with urinary incontinence?

A
  • Cardiovascular - Abdominal - Musculoskeletal - Neurologic - Genitourinary
27
Q

What testing can be done when testing for the cause of urinary incontinence? (5)

A
  1. Bladder diary 2. Stress test 3. PVR 4. Urinalysis 5. Renal function
28
Q

What 2 abnormalities can occur with pelvic floor weakness in women?

A
  1. Cystocele 2. Rectocele
29
Q

What is a postvoid residual test? What are abnormal results?

A

PVR tests the amount of urine in the bladder after voiding, either by catheterization or ultrasound. PVR >200mL —> suggests detrusor weakness and/or outlet obstruction.

30
Q

What complication can occur with urinary retention, and must be checked for if PVR is over 200?

A

Hydronephrosis! **More common in men than women.

31
Q

What lab testing should be done with urinary incontinence testing?

A
  • Renal function (BMP) - Urinalysis - Glucose - Calcium - Vitamin B12 - PSA - Urine cytology and cystoscopy if hematuria or pelvic pain present.
32
Q

When should you consider urodynamic testing?

A

When empiric therapy has failed, the diagnosis is unclear, or before surgical intervention.

33
Q

What is the goal of urinary incontinence management?

A

Relief of the most bothersome aspects, aka improve QOL.

34
Q

What are lifestyle and reversible factors that can be changed to improve incontinence?

A
  • Correct underlying medical illnesses and medications that may contribute to urinary incontinence. - Manage fluid intake: avoid caffeine, alcohol, and minimize evening intake. - Reduce constipation
35
Q

What behavioral therapies can help to improve urinary incontinence?

A
  1. Bladder training (effective for urge and stress UI) 2. Prompted voiding (cognitively impaired patients) 3. Pelvic muscle exercises (effective for urge and stress UI)
36
Q

Describe the technique one can do in order to suppress urgency.

A

Be still, contract the pelvic floor, and focus on relaxation of urgency.

37
Q

What is scheduled voiding?

A

When a cognitively intact patient first keeps a bladder diary recording the intervals between voids. Then using the shortest interval, schedule voids at this interval. After 2 days without leakage —> increase the time by 30-60 mins until can go 2-4 hours without leakage.

38
Q

What training technique can be used for UI in cognitively impaired patients?

A

Prompted voiding.

39
Q

What antimuscarinic medications are commonly used for the treatment of urinary incontinence?

A
  • Oxybutynin - Tolterodine (Detrol)– Dry mouth!! - Blurry vision - Constipation - Possibly cognitive
40
Q

What are the common ADEs of oxybutynin?

A
  • Dry mouth!! - Blurry vision - Constipation - Possibly cognitive
41
Q

When instructing a patient to do pelvic muscle exercises, how should you instruct them?

A
  1. Focus on isolation of the pelvic muscles (avoid the buttock, abdomen, and thigh mm contraction). 2. Moderate repetitions of the strongest possible contractions: 3 sets of 8-10 contractions help for 6-8 seconds. Start this 3-4x weekly. 3. Hold contractions for progressively longer times, up to 10 seconds if possible, and increase frequency.
42
Q

What adjunctive pelvic muscle therapies can be used?

A
  • Biofeedback - Electrical stimulation - Weighted vaginal cones - Pessaries (a plastic object that is inserted in the vagina for symptomatic pelvic organ prolapse)
43
Q

Can topical estrogen help with stress incontinence?

A

It is unclear….may reduce atrophic vaginitis, urethritis.

44
Q

What medication has been shown to stimulate urethral smooth-muscle contraction?

A

Alpha-adrenergic agonists

45
Q

Are there surgical options for treatment of stress incontinence?

A

highest cure rates of all treatment options, but there is a 10% complication rate. Options: colposuspension and slings.

46
Q

What are periurethral injections?

A

Collagen injections around the urethra that can lead to short term (<1 year) improvement.

47
Q

What is the treatment of stress incontinence in men post-proctatectomy?

A

Mild cases: - Pelvic muscle exercises - Periurethral injections More severe cases: - Protective garments - Catheters *Also can do artificial sphincter replacements (but high re-operation rate), and sling operations.

48
Q

How is overflow urinary incontinence managed?

A

treat underlying cause. - Reduce or stop drugs that are impairing detrusor contractility. - Bethanechol chloride - Intermittent clean catheterization - Protective garments- diapers

49
Q

What is the risk of using catheterization with urinary incontinence?

A

UTIs!! polymicrobial bactereriuria, nephrolithiasis, bladder stones, epididymitis, chronic renal inflammation, and pyelonephritis.

50
Q

Who should indwelling catheters be used for?

A
  1. Short-term decompression of acute urinary retention.
  2. Chronic retention not manageable surgically/medically
  3. Patients with wounds that must be kept clean of urine
  4. Very ill patients who cannot tolerate garment changes
  5. Patients who request catheterization despite informed consent regarding risks.
51
Q

How can you reduce the number of infections in people with catheters?

A
  1. Keep long-term care residents with catheters in separate rooms from each other. 2. Closed drainage systems.
52
Q

Should patients with catheters be cultured for bacteria?

A

NOT ROUTINELY! Only culture when patients are symptomatic

53
Q

How often should you change catheters in patients who use them chronically?

A

a month, but can keep them longer if the patient does not have a UTI. - If a patient has a recurrent blockage, then every 7-10 days.

54
Q

When should you use prophylactic antibiotics in patients with catheterization?

A

In HIGH RISK patients (i.e. with prosthetic heart valves) when they have short-term catheterization.

55
Q

What are the 8 risk factors for catheter blockage?

A
  1. Alkaline urine 2. Female gender 3. Poor mobility 4. Calciuria 5. Proteinuria 6. Copious mucin 7. Proteus colonization 8. Pre existent bladder stones

SUMGERI (14 decks)

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