Incontinence, Prostate Cancer, and BPH (Tyler)

Question 1

Acute Dysuria

Answer 1

<1 week

Question 2

Internal Dysuria

Answer 2

dysuria that is localized to the internal genital structures

Question 3

External Dysuria

Answer 3

Dysuria that is localized to the external genital structures and occurs as urine exits the body

Question 4

Urgency

Answer 4

A sudden, compelling need to urinate that is often accompanied by bladder discomfort and inability to void more than a minimal quantity of urine

Question 5

Frequency

Answer 5

urinating more frequent than usual without increase in total urine volume due to decrease bladder capacity to hold urine

Question 6

Nocturia

Answer 6

waking up to urinate 2 or more times during the night

Question 7

Voiding symptoms

Answer 7

symptoms that occur at time of urination including slow/intermittent urine stream and difficulty initiating urination (hesitancy) 
prolonged termination (dribbling)
and dysuria

Question 8

Storage symptoms

Answer 8

symptoms that occur during bladder storage and filling

including urgency, frequency, nocturia, and incontinence

Question 9

UTI

Answer 9

infection of urethra, bladder, prostate, or kidney

lower UTI implies infection of urethra/bladder

upper UTI implies kidney

Question 10

complicated UTI

Answer 10

uti in individual with functional or structural abnormalities of the urinary tract.

higher risk of treatment failure

Question 11

Nocturnal Polyuria age related and social related

Answer 11

Fluid intake
Late afternoon and evening intake
Caffeine
Alcohol

Question 12

Nocturnal Polyuria peripheral edema

Answer 12

Venous insufficiency

CHF

Question 13

Nocturnal Polyuria Medications

Answer 13

Gabapentin
Pregabalin
Thiazolidinediones
NSAIDs
Pyridine Calcium Blockers

Question 14

Stress Incontinence

Answer 14

leakage of Urine on coughing/sneezing/standings

Question 15

Urge incontinence

Answer 15

urgency and inability to delay urination

Question 16

Overflow incontinence

Answer 16

variable presentation

Question 17

Transient causes of incontinence

Answer 17

DIAPPERS

Delerium
Infection
Atrophic urethritis/vaginitis
Pharmaceuticals
Psychological factors (depression with psychomotor retardation)
Excess urinary output
Restricted mobility
Stool impaction

Question 18

pharmacology in transient incontinence

Answer 18

Potent diuretics

Anticholinergics

Psychotropics

Opioid analgesics

α-Blockers (in women)

α-Agonists (in men)

Calcium channel blockers

Question 19

established causes of incontinence

Answer 19

Detrusor overactivity
urethral incompetence
detrusor underactivity

Question 20

Detrusor overactivity

Answer 20

urge incontinence

Uninhibited bladder contractions that cause leakage

Most common cause of established geriatric incontinence, accounting for two-thirds of cases; usually idiopathic

Detrusor hyperactivity with incomplete contractions (DHIC) is a subtype of urge incontinence that can present with urgency with incomplete bladder emptying

Question 21

Urethral incompetence

Answer 21

stress incontinence

Urethral obstruction

Common in older men but rare in older women

May be due to prostatic enlargement, urethral stricture, bladder neck contracture, or prostatic cancer in men

Cystoceles or other anatomic problems can be causes in women

Question 22

Detrusor underactivity

Answer 22

overflow incontinence

least common cause of incontinence

may be idiopathic or due to sacral lower motor nerve dysfunction

Question 23

signs and symptoms of atrophic urethritis and vaginitis

Answer 23

Vaginal mucosal friability

Erosions

Telangiectasia

Petechiae

Erythema

Question 24

signs and symptoms of detrusor overactivity

Answer 24

(urge incontinence)

complaint of urinary leakage after onset of an intense urge to urinate that can’t be forestalled

standing full bladder stress test may result in second delay in release of urine

Question 25

signs and symptoms of urethral incompetence

Answer 25

stress incontinence Urinary loss occurs with laughing, coughing, or lifting heavy objects Most commonly seen in women but can be seen following prostatectomy in men A standing full bladder stress test (asking the patient to cough while standing) should result in immediate release of urine

Question 26

signs and symptoms of urethral obstruction

Answer 26

Common symptoms include dribbling, urge incontinence, and overflow incontinence Detrusor overactivity (which coexists in two-thirds of cases) may cause symptoms of urgency

Question 27

signs and symptoms of detrusor underactivity

Answer 27

overflow incontinence Urinary frequency, nocturia, and frequent leakage of small amounts An elevated postvoid residual (generally over 450 mL) distinguishes detrusor underactivity from detrusor overactivity and stress incontinence, but only urodynamic testing differentiates it from urethral obstruction in men

Question 28

Laboratory tests for incontinence

Answer 28

Review medications Check urinalysis, urine culture Consider tests for hyperglycemia, hypercalcemia, diabetes insipidus

Question 29

imagine for incontinence

Answer 29

US can determine postvoid residual in older men for whom surgery is planned urodynamic confirmation of obstruction is strongly advised

Question 30

diagnostic procedures for incontinence

Answer 30

To test for stress incontinence, have the patient relax her perineum and cough vigorously (a single cough) while standing with a full bladder 1Instantaneous leakage indicates stress incontinence if urinary retention has been excluded by postvoid residual determination using ultrasound A delay of several seconds or persistent leakage suggests the problem is caused by an uninhibited bladder contraction induced by coughing Because detrusor overactivity may be due to bladder stones or tumor, the abrupt onset of otherwise unexplained urge incontinence—especially if accompanied by perineal or suprapubic discomfort or sterile hematuria—should be investigated by cystoscopy and cytologic examination of the urine

Question 31

LUTS suggestive for BPH

Answer 31

urinary frequency—urination eight or more times a day urinary urgency—the inability to delay urination trouble starting a urine stream a weak or an interrupted urine stream dribbling at the end of urination nocturia—frequent urination during periods of sleep urinary retention urinary incontinence- the accidental loss of urine pain after ejaculation or during urination urine that has an unusual color or smell

Question 32

symptoms from BPH most often come from

Answer 32

blocked urethra bladder that is overworked from trying to pass urine through the blockage

Question 33

AUA scoring 0-5

Answer 33

``` 0 not at all 1 less than 1 time in 5 2 less than half the time 3 about half the time 4 more than half the time 5 almost always ```

Question 34

AUA questions

Answer 34

Over the past month how often.... had the sensation of failing to empty bladder had to urinate wi/in 2 hours of finishing have you found you stopped and started again several times have you found it difficult to postpone urination have a weak urinary stream had to push or strain to begin urination most typically get up to urinate from the time you went to bed at night

Question 35

AUA symptoms scale

Answer 35

0-7 mild 8-19 moderate >35 severe

Question 36

symptoms due to BPH often coexist with

Answer 36

symptoms over overactive bladder

Question 37

most common pharm for overactive bladder is

Answer 37

anticholinergics

Question 38

TULIP

Answer 38

Transurethral US guided laser induced prostatectomy

Question 39

Prostate cancer risk increase

Answer 39

2.5 fold if one first degree relative is affected 5 fold if more than one

Question 40

amount of prostate cancers that are hereditary

Answer 40

5-10%

Question 41

what percent of early onset prostate cancer are hereditary

Answer 41

40%

Question 42

when should you test someone above the age of 75 for PSA

Answer 42

higher than median PSA measured before age of 70

Question 43

most men with screen detected prostate cancer Tx

Answer 43

don't treat, observe

Question 44

if a man needs treatment for his prostate cancer how do you treat?

Answer 44

you don't send him to urology

Question 45

are DRE and PSA recommended for routine screening

Answer 45

negative

Question 46

DRE is considered when

Answer 46

in high risk patients and does not actually impact decision making

Question 47

if PSA is 4-7

Answer 47

refer to urology if symptom score is moderate to severe