Urinary incontinence Flashcards
What are the different types of urinary incontinence?
- Stress urinary incontinence
- Mixed urinary incontinence
- Urge urinary incontinence
What is the clinical presentation for stress urinary incontinence?
Urine leakage under stress such as coughing, laughing, sneezing
What is the clinical presentation for urge urinary incontinence?
Urine leaking with urgency and frequency
What is the clinical presentation for mixed urinary incontinence?
Urine leakage after stress and urgency
If a patient has a frequent dribble of urine what kind of incontinence is that?
Overflow incontinence
How do you evaluate for urinary incontinence?
- Medical history
- Physical exam
- Demonstration of stress incontinence
- Assessment of urethral mobility
- UA
- PVR
What is the normal frequency of urination per day?
8 times or less
What is the normal frequency of urination overnight?
1 time or less
How do you define microscopic hematuria?
> 3 RBCs per high power field
When do you further evaluate microscopic hematuria?
> 25 RBCs per high power field
What medical history do you care about in evaluating for urinary incontinence?
- Past medical history
- Past surgical history
- Medications being used
- Degree and severity of incontinence
- Aggravating factors and timing of leakage in relation to aggravating factors
What physical exam components do you perform to assess urinary incontinence?
- Weight
- Assess for prolapse
- Assess vaginal tissues
- Neuro exam
- Demonstation of stress incontinence with cough test
- Assess urethral mobility with Q tip test
What do you do if cough stress test negative in supine and standing positions and patient reports symptoms of stress incontinence?
Urodynamic testing
What do you do if cough stress test negative in supine and standing positions and patient reports symptoms of stress incontinence?
Urodynamic testing
What is an abnormal PVR test?
> 150cc
What are typical indications for clinical cystoscopy?
Hematuria
Recurrent UTIs
Refractory urge incontinence
In general what are the nonsurgical treatments for urinary incontinence?
Behavior modification
Pharmacologic therapy
What are behavior modifications for urinary incontinence?
Pelvic floor exercises
Weight loss
Dietary/fluid modification/bladder retraining
Devices (plugs, pessaries, weighted cones)
What kind of incontinence can you treat with medications?
Urge urinary incontinence
What medications are used for urge urinary incontinence?
Antimuscarinic meds
Beta 3 agonists
Onabotulinumtoxin A
How does antimuscarinic meds work for urge urinary incontinence?
Blocks parasympathetic M2/M3 receptors to inhibit involuntary detrusor contraction
What are the side effects of antimuscarinic meds?
Dry mouth
Constipation
Dry eyes
How do beta 3 agonists work?
Relaxes detrusor muscle and increases bladder capacity
What are side effects of beta 3 agonists?
Headache
Tachycardia
Diarrhea
When should you not use beta 3 agonists?
Uncontrolled severe HTN
Severe liver disease
Severe renal disease
What are side effects of Onabotulinumtoxin A?
UTI
Urinary retention
What are the surgical options for stress urinary incontinence?
Midurethral slings
Urethral bulking agents
Which candidates are urethral bulking agents more useful for?
Patients with stress incontinence with lack of urethral mobility
When is sacral neuromodulation used?
Urge urinary incontinence refractory to other treatments
What are complications for surgical procedures for urinary incontinence?
UTI
Surgical site bleeding
Urinary retention
Erosion of sling material
Worsening of incontinence
Injury to ureter or bowel
