Renal Clinical Medicine Part 5: Approach to Urinary Incontinence (Miller) Flashcards

1
Q

Transient urinary incontinence arises suddenly and lasts how long?

Is it reversible?

A

1) Less than 6 months

2) Yes

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2
Q

Which chronic urinary is defined as leakage of urine with coughing, sneezing, or physical exertion?

Which sex is it more common in?

A

1) Stress UI

2) Women

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3
Q

Which chronic urinary is defined as urine leakage with sudden compelling desire to void?

Which sex is it more common in?

A

1) Urge UI

2) Women and men

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4
Q

Which chronic urinary is defined as urinary retention from detrusor underactivity or outflow obstruction?

Which sex is it more common in?

A

1) Overflow UI

2) Men

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5
Q

What are specific risk factors for urinary incontinence in women?

In men?

A

1) Parity (especially vaginal deliveries) and menopause

2) Benign prostate hypertrophy

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6
Q

What structures function to prevent urinary leakage and when they lose strength/function they lead to stress UI?

A

1) Pelvic floor musculature
2) External sphincter
3) Endopelvic fascia

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7
Q

What structure when it involuntarily contracts leads to urge incontinence?

A

Detrusor muscle

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8
Q

What is the most common cause of overflow incontinence?

A

Enlarged prostate (BPH)

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9
Q

When performing a physical exam on a patient you suspect with UI, what should you include in the functional assessment?

A

1) Mental status
2) Mobility
3) BMI

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10
Q

When performing a physical exam on a patient you suspect with UI, what can be performed for provocation?

A

Cough stress test

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11
Q

In the evaluation of UI, the post-void residual volume test measures?

A

Completeness of emptying

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12
Q

In the evaluation of UI, voiding diaries are a reliable tool which measure?

A

1) Micturition chart
2) Frequency-volume
3) 24 hour urine production

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13
Q

What is valuable when incontinence diagnosis is uncertain after initial assessment, symptoms do not correlate with physical findings, or previous treatment failed?

When should this not be peformed?

A

1) Urodynamic studies

2) Initial workup

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14
Q

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?

A

Functional UI

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15
Q

Functional UI may be addressed by providing alternative receptacles such as?

A

Male urinal, commode, or condom catheter

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16
Q

What is done for conservative management of stress UI?

A

Pelvic floor muscle strengthening (Kegel exercises)

17
Q

What are options for pharmacologic treatment of urge UI?

A

1) Antimuscarinics

2) Mirabegron (B1 adrenergic agonists)

18
Q

What is given for pharmacologic treatment of overflow UI?

A

Alpha-adrenergic antagonists

19
Q

What do the anticholinergic drugs act on when treating urge incontinence?

A

Detrusor muscle

20
Q

In the treatment of urge UI, intravesical onabotulinumtoxin A induces chemical neuromodulation at what site?

A

The detrusor presynaptic NM junction