Renal. Incontinence + UW elderly incont (08-15) (1) Flashcards
UW incontinence.
STRESS. what symptoms?
leaking with Valsalva maneuver (caughing, sneezing, laughing)
this maneuver leads to increased intraabdominal pressure
UW incontinence.
leaking with Valsalva maneuver (caughing, sneezing, laughing)?
stress
UW incontinence.
STRESS. what treatment?4
lifestyle modifications
pelvic floor exercise
pessary and Kegel
pelvic floor surgery
FA: urethral sling procedure (WTF)
UW incontinence.
lifestyle modifications
pelvic floor exercise
pessary
pelvic floor surgery
in what?
stress
UW incontinence. URGENCY. Symptoms?
sudden, overwhelming, or frequent need to void
UW incontinence.
sudden, overwhelming, or frequent need to void?
Urgency
UW incontinence.
Urgency. Treatment? 3
Lifestyle modification
Bladder training
antimuscarinic drugs
UW incontinence.
Lifestyle modification
Bladder training
antimuscarinic drugs
in what?
Urgency
UW incontinence.
MIXED. symptoms?
Features of stress and urgency
UW incontinence.
Features of stress and urgency?
Mixed
UW incontinence. mixed treatment?
variable treatment depending on predominant symptoms
UW incontinence.
variable treatment depending on predominant symptoms
in what?
MIXED
UW incontinence.
OVERFLOW. symptoms?
Constant involuntary dribbling and incomplete emptying
UW incontinence.
Constrant involuntary dribbling and incomplete emptying
Overflow
UW incontinence.
OVERFLOW treatment? 3
Identification and correction of underlying cause
Cholinergic agonists
Intermitent self-catheterization
UW incontinence.
Identification and correction of underlying cause
Cholinergic agonists
Intermitent self-catheterization
in what?
Overflow
FA. incontinence. mechanism?
involuntary loss of urine cause by either bladder or urethral sphincter dysfunction.
FA. incontinence. Mneumonic of causes?
DIAPPERS
Delirium/confusion
Athrophic urethritis/vaginitis
Pharmaceutical
Psychiatric disorders (esp. depression)
Excessive urinary output (hyperglycemia, hypercalcemia)
Restricted mobility
Stool impaction
FA. incontinence.
Diagnosis. urine labs
Urinalysis - pyuria suggests UTI.
Creatinine - can reveal renal dysfunction if urinary obstruction leading to overflow is suspected.
FA. incontinence.
Diagnosis. what patients have to do to follow volume?
Voiding diaries - helps to define type of incontinence
FA. incontinence.
Diagnosis. instrumental testing?2
Urodynamic and radiographic testing - not routinely. used if considered surgery
FA. incontinence. Stress mechanism?
Urethral sphincter insufficiency caused by laxity of pelvic floor musculature
FA. incontinence. Stress in what patients? 2
multiparous women or after pelvic surgery
FA. incontinence. Urgency. how it happens?
unexpected urge to void unrelated to position or activity
FA. incontinence. Urgency. mechanism?
in bladder outlet obstruction (BPH or drugs that incr. sphrincter tone)
or
detrusor overactivity
FA. incontinence. Urgency.
pelvic floor exercise, bladder training
what drugs? 1st and 2nd line
Anticholinergic - 1st line
B agonists eg mirabegron - 2nd line
FA. incontinence. Overflow. what situation?
dribbling after incomplete emptying of bladder
FA. incontinence. Overflow. mechanim?
chronically distended bladder with intravesical pressure that just exceeds the outlet resistance –> small amount of urine to dribble out
FA. incontinence. Overflow. treatment
urethral cath in acute setting
treat underlying cause
timed voiding/catheterization
FA. incontinence.
Total. what situation?
uncontrolled loss and at all times and all positions
FA. incontinence.
Total. mechanism? 2
loss of sphincter efficiency (previous surgery, nerve damage, cancer infiltration)
Abnormal connection between urinary tract and skin (fistula)
FA. incontinence.
Total. treatment?
surgery
UW. incontinence in elderly. genitourinary causes? 4
decr. detrusor musle contractility, detrusor overactivity
Bladder/urethral obstruction (cancer, BPH)
Urethral sphincter/pelvic floow weakeness
Urogenital fistula
UW. incontinence in elderly. Neurologic causes? 3
Multiple sclerosis
Dementia (parkinson, alzheimer, NP hydrocephalus)
Spinal cord injury/disc herniation
UW. incontinence in elderly. Potentially reversible causes?
DIAPPERS
Delirium
Infection (UTI)
Pharmaceutical (alfa blockers, diuretics)
Psychological (depression)
Excessive urine output (DM, CHF)
Restricted mobility (post surgery)
Stool impaction
UW. incontinence in elderly. most common cause?
UTI
Once excluded –> additional tests to rule out other causes
UW. incontinence in elderly. 3 groups medications as cause
alpha blockers: relaxes urethra
Diuretics: xxcessive urine production
Anticholinergic, opiatres, CCB: urinary retention and overflow
