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Foundations III > Incontinence > Flashcards

Incontinence Flashcards

1
Q

Give some examples of stress urinary incontinence

A

cough, laugh, sneeze, physical exertion

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2
Q

Give an example of urge urinary incontinence

A

strong urge in the suprapubic area that can’t be held back

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3
Q

What typically causes continuous incontinence?

A

fistulas

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4
Q

5 underlying causes of urinary incontinence

A
  1. Intrinsic sphinteric deficiency
  2. Urethral hypermobility
  3. Detrusor overactivity
  4. Low bladder compliance
  5. Urinary retention
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5
Q

Urinary incontinence: precipitating factors

A
  • Cough
  • laugh
  • Movement
  • EtoH
  • Caffeine
  • Constipation
  • Immobility
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6
Q

What needs to be performed as part of the physical exam for a patient with urinary incontinence?

A
  • Female: pelvic exam
  • Male: prostate exam
  • Perineal sensation
  • Rectal Exam: stool impaction, bulbocavernosal reflex (squeeze glans look for anal wink)
  • Edema in LE
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7
Q

What is the cotton swab test?

A

During pelvic exam, cotton swab is placed in the urethra, if angle changes more than 30 degrees–> suggests hypermobility!

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8
Q

What will need to be looked at on urinalysis for patient with urinary incontinence?

A
  • glucosuria

- infection

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9
Q

What is the inital imaging to do for a patient with urinary incontinence?

A

voiding cystourethrogram

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10
Q

If you suspect a patient is having continous incontinence due to a fistula, what is the initial test?

A

Pyridium test (will turn urine orange)

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11
Q

What are some initial non-invasive options for a femal patient with urinary incontinence?

A
  • Behavioral therapy (ex. voiding diary, bladder training, weight loss, avoid constipation, elevate LE with edema)
  • Medication
  • Continence devices (Ex. pessary)
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12
Q

Pelvic Floor Muscle training (PFMT)

A

indicated for SUI, UUI, Mixed UI

  • maximal isometric contractions of pelvic floor muscles
  • 6-8 seconds
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13
Q

What is a good first line treatment medicine for Urinary incontinence?

A

Alpha-agonists (increases muscle tone or urinary sphincter)

Ex. Pseudoephedrine, ephedrine

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14
Q

Alpha agonists: contraindications

A
  • cardiac disease
  • uncontrolled HTN
  • narrow angle glaucoma
  • hyperthyroidism
  • DM
  • High risk for seizure
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15
Q

What are the two main contraindications for Duloxetine?

A
  1. nausea

2. Higher rate of suicide

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16
Q

What would be an example of a minimally invasive urinary incontinence treatment for females?

A

bulking agents injected need urethra

Ex. collagen, graphite, silicone

17
Q

What is the preferred surgical option for female urinary incontinence

A

Anterior repair (pubocervical fascia imbricated posteriorly to support bladder)

18
Q

What are some potential adverse reactions to placement of sling?

A
  • may erode into vagina causing dyspareunia

- Dysuria, hematuria, urinary urgency, urinary frequency, Recurrent UTI

19
Q

Name the 4 options for non-invasive urinary incontinence in female (Stress Urinary incontinence)

A
  1. Behavioral
  2. Pelvic Floor Muscle Training
  3. Medication
  4. Continence devices (ex. pessary)
20
Q

What should a patient with a new artificial urinary sphincter do daily?

A

pull down on the pump so that it doesn’t become encapsulated to high

21
Q

How long does the patient need to heal first before using their artificial sphincter?

A

6 weeks

22
Q

What must always be done before placing a urinary catheter in a patient with an artificial urinary sphincter?

A

the sphincter must be deactivated and locked in the open position

23
Q

When is the most common time for an infection to occur in a patient with an artificial urinary sphincter?

A

first 2 months

24
Q

What are the two big complications to be aware of for an artificial urinary sphincter?

A

infection and erosion

25
Q

Overactive bladder

A

urinary urgency + frequency

26
Q

Non-invasive options for urge incontinence

A
  1. Behavioral Therapy
  2. Estrogen
  3. Anticholinergic medication
  4. Beta adrenergic medication
27
Q

Minimally invasive tx options for urge incontinence

A
  1. Neuromodulation

2. Botulinum

28
Q

Who is topical estrogen contraindicated for?

A
  • venous thrombosis
  • PE
  • CVA
  • MI
  • Estrogen breast cancer
  • Liver dysfunction
29
Q

Anticholinergic medication: MOA

A

decrease detrusor muscle contractions

30
Q

Anticholinergic medication: contraindications

A
  • uncontrolled narrow angle glaucoma
  • myasthenia gravis
  • intestinal obstruction
  • gastric retention
  • urinary retention
31
Q

Anticholinergic medications: ADE

A
  • xerostomia (dry mouth)
  • constipation
  • dizziness
  • drowsiness
  • blurry vision
  • headache
32
Q

Anticholinergic medications for urge incontinence (examples)

A
  1. Oxybutynin
  2. Tolterodine
    3 Fesoterodine
33
Q

Mirabegron (Myrbetriq)

A
  • Beta adrenergic agonist
  • Stimulates beta 3 in the bladder
  • relaxes detrusor
  • MONITOR FOR HIGH BLOOD PRESSURE**
34
Q

Augmentation enterocystoplasty

A

-bladder dome opened and part of the intestines is attached to increase the bladder size

35
Q

Autoaugmentation

A

Detrusor muscle incised so bladder capacity expands

Foundations III (34 decks)

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