UI 1 Flashcards
What are the 6 types of Urinary Incontinence?
- Stress UI
- Urge UI
- Mixed
- Unaware (unconscious)
- Nocturnal enuresis
- Continuous
What are the 5 underlying pathophysiologies of UI?
- Intrinsic sphincteric deficiency (ISD)
- Urethral hypermobility
- Detrusor overactivity
- Low bladder compliance
- Urinary retention
Transient Causes of UI
DIAPPERS
- Delirium
- Infection
- Atrophic vaginitis
- Pharmaceuticals/Polypharmacy
- Psychological
- Excessive Urine Production
- Restricted Mobility
- Stool Impaction / Constipation
2 exam findings on rectal exam for UI
- stool impaction
- bulbocavernosal reflex
5 PE components for UI
- Female: pelvic
- Male: prostate
- Perineal sensation
- Rectal exam: stool impaction , bulbocavernosal reflex
- LE: edema
3 components of PE for pelvic exam of female for eval of UI
- Vaginal epithelium: atrophic vaginitis
- Cotton swab test (place cotton swab in urethra, change of 30 degrees w/ strain = urethral hypermobility)
- Cough test (observe for leaking w/ cough)
5 studies
- UA / culture (glucosuria, infection)
- Voiding diary (voids, incontinence, fluid consumption, BMs)
- Post-void residual: retention
- Cytoscopy: stricture, tumor
- Urodynamic study
3 imaging studies for UI
- Voiding cystourethrogram
- Pelvic Imaging (MRI)
- Neurologic Directed Imaging
What are the tx for UI caused by these?
- Delirium
- Infection
- Atrophic Vaginitis
- Pharmaceuticals
- Psychological
- Excessive UOP
- Restricted mobility
- Stool impaction/constipation
- Delirium –> tx underlying cause
- Infection–> abx
- Atrophic Vaginitis–> topical vaginal estrogens
- Pharmaceuticals–> elimination/adjustments
- Psychological–>psych referral
- Excessive UOP–>tx/manage cause, alter timing of fluid intake/diuretics, elevation of LE
- Restricted mobility–> bedside commode / urinal
- Stool impaction/constipation–> bowel management
Tx of Urinary Retention?
(4)
-
tx to empty bladder
- avoid certain OTC meds (cough/cold meds)
- Catheterization
- BPH medication
- Surgery
Test and Tx for Continuous Incontinence caused by vesicovaginal fistula
- Test: Pyridium test: place tampon in vagina, give Pyridium, if tampon is orange the pt has fistula.
- Tx: surgery
3 Non-Invasive Tx for Female Stress Urinary Incontinence (SUI)?
- Behavioral Therapy
- Medication
- Continence Devices (pessary, catheter)
Minimally Invasive Tx for Female SUI
Bulking Agents
4 Surgical Tx for Female SUI
- Anterior Repairs
- Suspensions
- Artificial Urinary Sphincter
- Sling procedures
4 tx options for Non-Invasive Behavioral Therapy for Female SUI
- Pelvic Floor Muscle Training (PFMT)
- Avoidance of constipation
- Elevation of edematous lower extremities (helpful for night time incontinence)
- Timed voiding to prevent leakage
2 components of bladder training for female SUI
- Gradually increase time between voids
- Suppress urge w/ breathing exercises, mental imagery, distraction, or pelvic floor muscle contractions
Tx for what?
- Fluid intake modification: drink fluids earlier in day, avoid right before bed time
- Dietary modification: avoid bladder irritants (caffeine, ETOH, spicy foods, acidic foods)
- Weight loss (decrease in abd pressure / pressure on bladder)
Tx for Female SUI
Tx for Female SUI (non-invasive)
- Avoidance of ____
- Elevation of edematous LE during what time of day?
- Compression stockings
- Void before ____
- constipation
- PM prior to hs to mobilize fluid
- going to sleep to avoid nocturia
Tx for Female SUI : Pelvic Floor Muscle Training (PFMT)
- Indicated for which 3 types of UI?
- Maximal isometric contractions of pelvic floor muscles
- Contract for __ to __ seconds, relax
- __ repetitions
- __ sets / day
- Teaching by professional
- SUI, UUI, Mixed UI
- 6-8
- 10 reps
- 3 sets
Which medication for tx of femle SUI?
- increases muscle tone of urinary sphincter
- Not FDA approved for this indication
- Pseudoephedrine, ephedrine, imipramine
Alpha Agonists
7 Contraindications of Alpha Agonists (Pseudoephedrine, ephedrine, imipramine)
- cardiac disease
- uncontrolled HTN
- narrow angle glaucoma
- hyper-thyroidism
- DM
- MAOI use (monoamine oxidase inhibitors)
- at risk for seizures
Which medication for tx of Female SUI?
- Serotonin & NE reuptake inhibitor
- Nausea
- Higher than expected rate of suicide
- Not FDA approved for this indication
Duloxetine
What are the 3 “continence devices” for tx of female SUI?
- Pessary (taco time) - changed monthly
- Indwelling urinary catheter (urethral or suprapubic)
- Urethral occlusive device
Tx for Female SUI : Bulking Agents
- Injection of material adjacent to the proximal ___/____
- Coats the ________
- Increases bladder outlet resistance
- Generally done ______
- Single or multiple txs?
- urethra/bladder neck
- urethral mucosa
- transurethrally
- multiple
Tx for Female SUI : Bulking Agents
- 4 types of agents?
- Skin test to check for ____
- Can migrate to ___
- ____ visible on x-rays
- collagen, graphite, calcium hydroxyapatite, silicone
- allergic rxn
- lymphatic system
- calcium
4 types of surgeries for tx of Female SUI?
- Anterior repair
- Suspension
- Artificial Urinary Sphincter
- Sling
Which surgery for Female SUI?
- _____ fascia imbricated ____ to support the bladder
Anterior Repair
- pubocervical / posteriorly
Which surgery for Female SUI?
- Marshall-Marchetti-Krantz (MMK) - periurethral
- Burch - perivesical
Suspension
In which patients would you use a “sling” surgery for tx of Female SUI?
pts w/ urethral hypermobility (>30 degrees)
Tx of Female SUI
- like a “hammock” under urethra
- autologous fascia
- allograft
- xenograft (porcine, bovine)
- synthetic
Sling
Surgery for Female SUI
- If there is overcorrection, urinary retention may require intermittent _____ (temporarily)
- Possibility of sling erosion into the ___, ___, ___
- leading to sxs including….
- catheterization
- vagina, urethra/bladder
- dyspareunia, vag pain, vag discharge, vag bld
- dysuria, hematuria, urinary urgency, urinary freq, recurrent UTI, recurrent SUI
What tx of female SUI is considered “minimally invasive?”
Bulking Agents
