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MJ- F3 E1: Urology > UI 1 > Flashcards

UI 1 Flashcards

1
Q

What are the 6 types of Urinary Incontinence?

A
  1. Stress UI
  2. Urge UI
  3. Mixed
  4. Unaware (unconscious)
  5. Nocturnal enuresis
  6. Continuous
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2
Q

What are the 5 underlying pathophysiologies of UI?

A
  • Intrinsic sphincteric deficiency (ISD)
  • Urethral hypermobility
  • Detrusor overactivity
  • Low bladder compliance
  • Urinary retention
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3
Q

Transient Causes of UI

A

DIAPPERS

  • Delirium
  • Infection
  • Atrophic vaginitis
  • Pharmaceuticals/Polypharmacy
  • Psychological
  • Excessive Urine Production
  • Restricted Mobility
  • Stool Impaction / Constipation
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4
Q

2 exam findings on rectal exam for UI

A
  • stool impaction
  • bulbocavernosal reflex
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5
Q

5 PE components for UI

A
  • Female: pelvic
  • Male: prostate
  • Perineal sensation
  • Rectal exam: stool impaction , bulbocavernosal reflex
  • LE: edema
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6
Q

3 components of PE for pelvic exam of female for eval of UI

A
  • 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)
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7
Q

5 studies

A
  • UA / culture (glucosuria, infection)
  • Voiding diary (voids, incontinence, fluid consumption, BMs)
  • Post-void residual: retention
  • Cytoscopy: stricture, tumor
  • Urodynamic study
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8
Q

3 imaging studies for UI

A
  • Voiding cystourethrogram
  • Pelvic Imaging (MRI)
  • Neurologic Directed Imaging
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9
Q

What are the tx for UI caused by these?

  • Delirium
  • Infection
  • Atrophic Vaginitis
  • Pharmaceuticals
  • Psychological
  • Excessive UOP
  • Restricted mobility
  • Stool impaction/constipation
A
  • 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
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10
Q

Tx of Urinary Retention?

(4)

A
  • tx to empty bladder
    • avoid certain OTC meds (cough/cold meds)
    • Catheterization
    • BPH medication
    • Surgery
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11
Q

Test and Tx for Continuous Incontinence caused by vesicovaginal fistula

A
  • Test: Pyridium test: place tampon in vagina, give Pyridium, if tampon is orange the pt has fistula.
  • Tx: surgery
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12
Q

3 Non-Invasive Tx for Female Stress Urinary Incontinence (SUI)?

A
  • Behavioral Therapy
  • Medication
  • Continence Devices (pessary, catheter)
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13
Q

Minimally Invasive Tx for Female SUI

A

Bulking Agents

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14
Q

4 Surgical Tx for Female SUI

A
  • Anterior Repairs
  • Suspensions
  • Artificial Urinary Sphincter
  • Sling procedures
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15
Q

4 tx options for Non-Invasive Behavioral Therapy for Female SUI

A
  • Pelvic Floor Muscle Training (PFMT)
  • ​Avoidance of constipation
  • Elevation of edematous lower extremities (helpful for night time incontinence)
  • Timed voiding to prevent leakage
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16
Q
A
17
Q

2 components of bladder training for female SUI

A
  • Gradually increase time between voids
  • Suppress urge w/ breathing exercises, mental imagery, distraction, or pelvic floor muscle contractions
18
Q

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)
A

Tx for Female SUI

19
Q

Tx for Female SUI (non-invasive)

  • Avoidance of ____
  • Elevation of edematous LE during what time of day?
  • Compression stockings
  • Void before ____
A
  • constipation
  • PM prior to hs to mobilize fluid
  • going to sleep to avoid nocturia
20
Q

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
A
  • SUI, UUI, Mixed UI
  • 6-8
  • 10 reps
  • 3 sets
21
Q

Which medication for tx of femle SUI?

  • increases muscle tone of urinary sphincter
  • Not FDA approved for this indication
  • Pseudoephedrine, ephedrine, imipramine
A

Alpha Agonists

22
Q

7 Contraindications of Alpha Agonists (Pseudoephedrine, ephedrine, imipramine)

A
  • cardiac disease
  • uncontrolled HTN
  • narrow angle glaucoma
  • hyper-thyroidism
  • DM
  • MAOI use (monoamine oxidase inhibitors)
  • at risk for seizures
23
Q

Which medication for tx of Female SUI?

  • Serotonin & NE reuptake inhibitor
  • Nausea
  • Higher than expected rate of suicide
  • Not FDA approved for this indication
A

Duloxetine

24
Q

What are the 3 “continence devices” for tx of female SUI?

A
  • Pessary (taco time) - changed monthly
  • Indwelling urinary catheter (urethral or suprapubic)
  • Urethral occlusive device
25
Q

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?
A
  • urethra/bladder neck
  • urethral mucosa
  • transurethrally
  • multiple
26
Q

Tx for Female SUI : Bulking Agents

  • 4 types of agents?
  • Skin test to check for ____
  • Can migrate to ___
  • ____ visible on x-rays
A
  • collagen, graphite, calcium hydroxyapatite, silicone
  • allergic rxn
  • lymphatic system
  • calcium
27
Q

4 types of surgeries for tx of Female SUI?

A
  • Anterior repair
  • Suspension
  • Artificial Urinary Sphincter
  • Sling
28
Q

Which surgery for Female SUI?

  • _____ fascia imbricated ____ to support the bladder
A
  • pubocervical / posteriorly
29
Q

Which surgery for Female SUI?

  • Marshall-Marchetti-Krantz (MMK) - periurethral
  • Burch - perivesical
A

Suspension

30
Q

In which patients would you use a “sling” surgery for tx of Female SUI?

A

pts w/ urethral hypermobility (>30 degrees)

31
Q

Tx of Female SUI

  • like a “hammock” under urethra
  • autologous fascia
  • allograft
  • xenograft (porcine, bovine)
  • synthetic
A

Sling

32
Q

Surgery for Female SUI

  • If there is overcorrection, urinary retention may require intermittent _____ (temporarily)
  • Possibility of sling erosion into the ___, ___, ___
    • leading to sxs including….
A
  • catheterization
  • vagina, urethra/bladder
  • dyspareunia, vag pain, vag discharge, vag bld
  • dysuria, hematuria, urinary urgency, urinary freq, recurrent UTI, recurrent SUI
33
Q

What tx of female SUI is considered “minimally invasive?”

A

Bulking Agents

MJ- F3 E1: Urology (12 decks)

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