Renal Clinical Medicine Part 5: Approach to Urinary Incontinence (Miller) Flashcards
Transient urinary incontinence arises suddenly and lasts how long?
Is it reversible?
1) Less than 6 months
2) Yes
What is Stress Urinary Incontinence?
Which sex is it more common in?
1) Leakage of urine with coughing, sneezing, or physical exertion
2) Women
What is Urge Urinary Incontinence?
Which sex is it more common in?
1) Urine Leakage with sudden compelling desire to void
2) Women and men
What is Overfill Urinary Incontinence (Chronic)?
Which sex is it more common in?
What are the causes of Overfill UI?
1) Urinary retention from detrusor under activity or outflow obstruction
2) Men
3) Blocked urethra, Bladder weakness (Diabetes, decreased nerve function, alcohol), and enlarged prostate
What are specific risk factors for urinary incontinence in women?
In men?
1) Parity (especially vaginal deliveries) and menopause
2) Benign prostate hypertrophy
What structures function to prevent urinary leakage and when they lose strength/function they lead to stress UI?
1) Pelvic floor musculature
2) External sphincter
3) Endopelvic fascia
What structure when it involuntarily contracts leads to urge incontinence?
Detrusor muscle
What is the most common cause of overflow incontinence?
Enlarged prostate (BPH)
When performing a physical exam on a patient you suspect with UI, what should you include in the functional assessment?
1) Mental status
2) Mobility
3) BMI
When performing a physical exam on a patient you suspect with UI, what can be performed for provocation?
Cough stress test
In the evaluation of UI, the post-void residual volume test measures?
What else should be ordered?
Completeness of emptying
UA with calorimetric reagent test + microscopy
Urine Culture
Voiding diary
Pad testing
In the evaluation of UI, voiding diaries are a reliable tool which measure?
1) Micturition chart (timing of each void)
2) Frequency-volume
3) 24 hour urine production
When is Urodynamic studies valuable?
When should this not be performed?
1)
- Incontinence diagnosis is uncertain after initial assessments
- Sx do not correlate with physical findings
- Previous Tx failed
2) Initial workup
What is characterized as cognitive, functional, or mobility difficulties that impair patients’ ability to use the toilet, but without a failure of bladder function or neurologic control of urination?
Functional UI
Functional UI may be addressed by providing alternative receptacles such as?
Male urinal, commode, or condom catheter
