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Adult/Ped Medicine 6 > Incontinence - Bishay > Flashcards

Incontinence - Bishay Flashcards

1
Q

Domains for defining continence (4)

A

Symptoms: patient/caregiver description
Signs: objective demonstration of urine loss
UDS observation
Condition: lower urinary tract pathophysiology

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2
Q

What is the involuntary loss of urine and is not necessarily a part of aging?

A

Incontinence

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3
Q

The micturation control center in your frontal cortex does what?

A

Inhibitory signals to the detrusor.

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4
Q

The pontine micturation center does what?

A

Coordinates Urinary Sphincter with detrusor

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5
Q

The spinal cord had what role in micturation?

A

Communication between brainstem and sacral spinal cord. Sacral spinal cord is spinal reflex center.

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6
Q

Classes of incontinence

A 
Transient- Important in elderly
Urge- Variant overactive bladder syndrome
Stress- Leak with coughing
Mixed: Stress and urge
Total/continuous: rare
Overflow: neurogenic baldder
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7
Q

Functional Classification of incontinence

A

1) Failure to empty (Bladder underactivity, obstruction)

2) Failure to store: (urethral incompetence, bladder overactivity)

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8
Q

Urologist Referral for Incontinence

A
  • Bothersome Stress Incontinence
  • Refractory Urge/Urge Incontinence
  • Recurrent symptomatic UTI’s with urinary incontinence
  • Pelvic floor prolapse
  • Prostate cancer
  • Bladder cancer
  • Hematuria
  • Urinary retention not responding to management
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9
Q

Urethral sphincter Etiology: Urethral resistance- When will you see leakage of urine?

A

During filling of bladder with valsalva

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10
Q

Results for post void residuals

A

400 consider intermittent catheterization or indwelling foley catheter and further urologic consult

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11
Q

Testing for incontinence

A

Labs: UA with possible culture

Urodynamics testing: Stress testing, uroflow, postvoid residual, voiding cystometrogram, cystourethroscopy

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12
Q

How should you begin therapy for incontinence?

A
  • Begin with conservative therapy (Lifestyle changes- avoid caffeine, alcohol, etc.)
  • Bladder diary
  • Behavioral training: Timed, double voiding
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13
Q

Pharmaceutical therapy for incontinence

A

1) Anticholinergic Agent- Promote urinary storage by blocking Mu receptor. SE: Dry mouth, constipation
2) Beta 3 agonists- Mirabegron (Myrbetriq): Stimulates bladder relaxation promoting storage. SE: Occasional HTN
3) Tricyclic antidepressants (Imipramine)- consider for mixed incontinence
4) Estrogen: Elderly

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14
Q

Treatment modalities for incontinence- Surgery for Overactive bladder:

A

1) Catheter (intermittent, indwelling)

2) Surgery: Neuromodulation, Botulinum toxin, augmentation cytoplasty, denervation

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15
Q

Surgery for Stress Incontinence

A

1) Retropubic suspensions
2) Mid-urethral sling
3) Pelvic organ prolapse repair
4) Collaen injections
5) Artificial urinary sphincter

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16
Q

Barrier methods for Incontinence

A

Pads, Absorbant garments

17
Q

Risk factors for incontinence in women

A 
Pregnancy and childbirth
Obesity
Endocrine (diabetes, menopause)
Pulmonary (persistent cough)
Neurological (dementia)
18
Q

Risk factors for incontinence in men

A

Surgical interventions
Neurological (dementia)
Endocrine (diabetes)

19
Q

Sympathetic Nervous Control of Micturation

A

Bladder Filling:

  • inhibits detrusor muscle through B receptors
  • activates internal urethral sphincter and proximal urethral constriction through hypogastric nerve
20
Q

Parasympathetic Nervous Control of Micturation

A

Micturation

  • suppression of sympathetics
  • stimulates detrusor smooth muscle through pelvic plexus from sacral segments (S2-S4)
21
Q

Transient Incontinence

DIAPPERS

A 
D - delirium
I - infection
A - atrophic vaginitis
P - pharmacologic
P - psychological
E - endocrine
R - restricted mobility
S - stool impaction
22
Q

Bladder Irritants

A 
Acidic food
Citrus
Caffeine
EtOH
Spicy foods
23
Q

Urologist Referral for Incontinece

A
  • Bothersome Stress Incontinence
  • Refractory Urge/Urge Incontinence
  • Recurrent symptomatic UTI’s with urinary incontinence
  • Pelvic floor prolapse
  • Prostate cancer
  • Bladder cancer
  • Hematuria
  • Urinary retention not responding to management

Adult/Ped Medicine 6 (14 decks)

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