UI 2 Flashcards
What are the 3 parts of an Artificial Urinary Sphincter?
- Cuff
- Reservoir
- Pump
Artificial Urinary Sphincter - Cuff
- Cuff approach for men? / Placement?
- Cuff approach for women? / Placement?
-
Men: Perineal approach
- encircles urethra
-
Women: Transvaginal or Transabdominal approach
- placed at bladder neck
Artificial Urinary Sphincter
- Where is the reservoir placed?
Posterior to abdominal wall
Artificial Urinary Sphincter
- Where is the pump placed in men?
- Tends to move ___ leading to what?
- Pt instructed to do what?
- scrotum
- upward –> position too high to operate easily
- pull downward on pump daily to prevent encapsulation in high position
Artificial Urinary Sphincter
- Where is pump placed in women?
Labia majora
Artificial Urinary Sphincter
- Cuff left in open position (deactivated) for __ weeks post-op to allow healing w/o urethral pressure
- Return in __ weeks for activation & instruction
- 6
- 6
Artificial Urinary Sphincter
- What should always be done prior to placing a urinary catheter??
- ALWAYS deactivate device (pump and lock in open position)
Artificial Urinary Sphincter
- Be alert to signs and sxs of complications, especially which 2??
Infection & Erosion
Infection from Artificial Urinary Sphincter
- Occurs within the first __ months
- 3-5 % incidence
- ___, ___, ___ near pump or cuff
- 2 signs
- Which 2 bacteria?
- Tx?
- 2
- pain, edema, erythema
- leukocytosis, fever
- E. coli or Staph
- Explanation & Abx
Erosion from Artificial Urinary Sphincter
- How is it prevented?
- 5% incidence
- More common if what?
- ___, ___, ___
- Explanation
- Re-implant after more than __ months later
- Avoid harsh perineal pressure (motorcycle, bicycle, horseback, sitting on hard surface w/o pad)
- pelvic radiation
- dysuria, hematuria, recurrent infections
- 3
Urge or overactive?
- episodic involuntary loss of urine, immediately preceded by or associated w/ urgency
Urge incontinence
Urge or Overactive?
- urinary urgency, usually associated w/ frequency
Overactive bladder
4 “non-invasive” tx for urge incontinence / overactive bladder
- Behavioral Therapy
- Estrogen
- Anticholinergic med
- Beta adrengergic med
2 “minimally invasive” tx for urge incontinence / overactive bladder
- Neuromodulation (sacral, tibial) w/ needle
- Botulinum
3 “surgical” tx for urge incontinence / overactive bladder
- augmentation enterocystoplasty
- autoaugmentation
- urinary diversion
Estrogen tx for urge incont / overact bladder
- topical vaginal
- Contraindicated if hx of what 7 things?
- venous thrombosis
- PE
- CVA
- MI
- estrogen dependent cancer (breast)
- abnormal genital bleeding
- liver dysfunction
Which med for urg incont / overact bladder?
- Inhibit the muscarinic cholinergic receptors
- Decrease detrusor muscle contractions
Anticholingergic
5 contraindications of anticholinergic med for urge incont / overact bladder?
- Uncontrolled narrow angle glaucoma
- myasthenia gravis
- intestinal obstruction
- gastric retention
- urinary retention
What are the 6 SE of anticholinergic med for urge incont / overactive bladder?
- Xerostomia (dry mouth)
- constipation
- dizziness
- drowsiness
- blurry vision
- HA
(DDD-BCH)
What are the 2 anticholinergic meds and what forms do they come in?
-
Oxybutynin
- immediate release
- extended release
- patch
- gel
-
Tolterodine
- immediate release
- extended release
(For both meds, extended is preferred)
Besides Oxybutynin & Tolterodine, what other 4 anticholinergics are there?
- Fesoterodine
- Darifenacin
- Solifenacin
- Trospium
What med for urge incont / overact bladder?
- Mirabegron
- Stimulates Beta-3 receptors in bladder
- relaxes detrusor
- higher bladder capacity
- Does what to cAMP and intracellular Ca?
- Monitor what?
Beta Adrenergic Agonist
- increases cAMP, decreases Ca
- monitor for increased BP
Minimally Invasive tx of Urge / Overactive w/ Botulinum Toxin
- injected cystoscopically into ___ muscle
- effects last __ to __ months
- detrusor
- 3 - 12
Minimally Invasive tx for urg/overactive w/ Sacral Neuromodulation (Interstim)
- Electrical stimulation of __ ___ nerve to modify voiding reflex
- Stage 1: electrode is placed near __ nerve. Connected to a generator worn on belt and activated
- Stage 2: if __ week trial successful, generator is placed where?
- S3 afferent
- S3
- 2 / internally
Minimally invasive tx for urge / overactive w/ Posterior Tibialis Nerve Stimulation (PTNS)
- Where is procedure done?
- Electrode placed where?
- Electrical stimulation for __ mins weekly for __ weeks.
- In office
- superior to / posterior to medial malleolus of either leg
- 30 / 12
Augmentation enterocystoplasy surgical tx for urge / overactive
- Bladder dome opened
- Detubularized intestinal segment appended to ___
- Increases ______
- Decreases ____ & ____
- bladder
- bladder capacity
- intravesical voiding pressure & incontinence
Autoaugmentation enterocystoplasy surgical tx for urge / overactive
- Detrusor muscle of dome of bladder incised
- ____ remains intact
- Bladder capacity ___
- Intravesical pressures ____
- Decreased incontinence
- urothelium
- expands
- lower
Urinary Diversion surgery to tx urge / overactive
- Urine bypasses bladder via ____
Ileal conduit
