Urinary Incontinence Flashcards
Name the 5 types of UI
- Stress
- Urge
- Overflow
- Functional
- Mixed
Classic sx with stress UI
- anything increase intra-abd pressure: sneezing, laughing, coughing, lifting
What type of UI does atrophic urethrits and s/p prostatectomy associated with?
- Atrophic: Stress and Urge
- Prostatectomy: stress
Mechanism of Stress UI
- compromised sphincter tone
- Outlet incompetence
RIsk factors to develop stress UI: male and female
Male: s/p radical prostectomy
- Female: multiple Vag deliveries, pelvic sx, menopausal atrophy of the urethra/VJ
Rs for stress UI
- Kegel
- ALpha agonists: increase urethral sphincter tone
- topical estrogen if 2/2/ atrophic vaginitis/urethritis
- occlusive devices, pessaries
What are examples of alpha agonists for stress UI?
- Pseudoephedrine
- Imipramine
What’s mechanism for urge UI?
- destrusor hyperactivity
What’s classic sx of urge UI
- urgent, irrepressible need to void immediately followed by large volume of urine
- Often in the setting of nocturia and nocturnal incontinence
Diuretic med and atrophic vaginitis/urethritis are a/w which type of UI
- Diuretics: urge
- Atrophic: both stress and urge
What’s the reason for destrusor over-activity?
- idiopathic
- dysfunction of frontal mictuition inhibitory center (stroke, dementia)
Rx for urge UI?
- Bladder training: void every 2-3 hours while awake
- Anticholinergic/Antimuscurinic: relax destrusor
Example of Anticolinergic/Antimuscurinics for urge UI?
Oxybutynin - CI in elderly with delirium
What’s mechanism of overflow UI?
- Destrusor hypoactive - can be neurogenic or pharmacological (anticholinergic and opioids)
- Obstruction (like by BPH)
What’s classic sx of overflow UI?
- Continue dribbling of urine from overly full bladder
What type of UI is most common in men?
Overflow (by BPH)
Anticholinergic will cause…urinary retention or incontinence, and precipirate to which type of urinary incontinence?
- cause destrusor underactivity -> overflow incontinence
- thus also the treatment for urge incontinence
Rx for overflow UI
- to decrease urethral sphincter tone (opposite to stress UI treatment): alpha-antagonist: tamsulosin, BPH
- to increase bladder contractility: prochlinergics (bethanechol)
Procholinergic drug is good for what type of UI and will worsen what type of UI?
- Procholinergic: decrease urinary retention by increase destrusor tone, so good for treating overflow incontinent
- Then can worsen urge incontinence
Imipramine has which two properties make it a good choice for mix type UI (mixed of urge and stress)
- anticholinergic: good for urge UI (dec bladder tone, hold more urine)
- alpha-agonist: increase urethral sphincter tone -> good for stress
In severe, refractory case of UI, what type of nerve procedure can be considered?
- Sacral nerve stimulation
Summary of treating URGE UI
- Bladder training
- Oxybutynin
Summary of treating Stress UI
- Bladder training, Kegel exercises
- Alpha agonist: Pseudoephedrine, imipramine
- Topical estrogen if 2/2 atrophic vaginitis/urethritis
- Pessary
Summary of Overflow UI treatment
- Bladder decompression: self-cath
- Alpha- antagonist for BPH
- Procholinergic can be tried, like Bethanecol, but less effective
- Dilate or stent urethral stricture, reduc cystoceles.
