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GAM > Urinary Incontinence > Flashcards

Urinary Incontinence Flashcards

1
Q

Name the 5 types of UI

A
  • Stress
  • Urge
  • Overflow
  • Functional
  • Mixed
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2
Q

Classic sx with stress UI

A
  • anything increase intra-abd pressure: sneezing, laughing, coughing, lifting
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3
Q

What type of UI does atrophic urethrits and s/p prostatectomy associated with?

A
  • Atrophic: Stress and Urge

- Prostatectomy: stress

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4
Q

Mechanism of Stress UI

A
  • compromised sphincter tone

- Outlet incompetence

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5
Q

RIsk factors to develop stress UI: male and female

A

Male: s/p radical prostectomy

- Female: multiple Vag deliveries, pelvic sx, menopausal atrophy of the urethra/VJ

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6
Q

Rs for stress UI

A
  • Kegel
  • ALpha agonists: increase urethral sphincter tone
  • topical estrogen if 2/2/ atrophic vaginitis/urethritis
  • occlusive devices, pessaries
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7
Q

What are examples of alpha agonists for stress UI?

A
  • Pseudoephedrine

- Imipramine

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8
Q

What’s mechanism for urge UI?

A
  • destrusor hyperactivity
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9
Q

What’s classic sx of urge UI

A
  • urgent, irrepressible need to void immediately followed by large volume of urine
  • Often in the setting of nocturia and nocturnal incontinence
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10
Q

Diuretic med and atrophic vaginitis/urethritis are a/w which type of UI

A
  • Diuretics: urge

- Atrophic: both stress and urge

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11
Q

What’s the reason for destrusor over-activity?

A
  • idiopathic

- dysfunction of frontal mictuition inhibitory center (stroke, dementia)

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12
Q

Rx for urge UI?

A
  • Bladder training: void every 2-3 hours while awake

- Anticholinergic/Antimuscurinic: relax destrusor

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13
Q

Example of Anticolinergic/Antimuscurinics for urge UI?

A

Oxybutynin - CI in elderly with delirium

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14
Q

What’s mechanism of overflow UI?

A
  • Destrusor hypoactive - can be neurogenic or pharmacological (anticholinergic and opioids)
  • Obstruction (like by BPH)
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15
Q

What’s classic sx of overflow UI?

A
  • Continue dribbling of urine from overly full bladder
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16
Q

What type of UI is most common in men?

A

Overflow (by BPH)

17
Q

Anticholinergic will cause…urinary retention or incontinence, and precipirate to which type of urinary incontinence?

A
  • cause destrusor underactivity -> overflow incontinence

- thus also the treatment for urge incontinence

18
Q

Rx for overflow UI

A
  • to decrease urethral sphincter tone (opposite to stress UI treatment): alpha-antagonist: tamsulosin, BPH
  • to increase bladder contractility: prochlinergics (bethanechol)
19
Q

Procholinergic drug is good for what type of UI and will worsen what type of UI?

A
  • Procholinergic: decrease urinary retention by increase destrusor tone, so good for treating overflow incontinent
  • Then can worsen urge incontinence
20
Q

Imipramine has which two properties make it a good choice for mix type UI (mixed of urge and stress)

A
  • anticholinergic: good for urge UI (dec bladder tone, hold more urine)
  • alpha-agonist: increase urethral sphincter tone -> good for stress
21
Q

In severe, refractory case of UI, what type of nerve procedure can be considered?

A
  • Sacral nerve stimulation
22
Q

Summary of treating URGE UI

A
  • Bladder training

- Oxybutynin

23
Q

Summary of treating Stress UI

A
  • Bladder training, Kegel exercises
  • Alpha agonist: Pseudoephedrine, imipramine
  • Topical estrogen if 2/2 atrophic vaginitis/urethritis
  • Pessary
24
Q

Summary of Overflow UI treatment

A
  • Bladder decompression: self-cath
  • Alpha- antagonist for BPH
  • Procholinergic can be tried, like Bethanecol, but less effective
  • Dilate or stent urethral stricture, reduc cystoceles.
25
Q

(Side) Effect of Anticholinergic

A 
Hot as a hare (Hyperthermia)
Dry as a bone (Dry Skin)
Red as a beet (Flushed)
Blind as bat (Mydriasis)
Mad as a hatter (Delirium)
Full as a vaze (Urinary retention)
26
Q

A list of transient cause of UI

A 
DIAPPER
D - delirium
I - infection/UTI
A - atrophic vaginitis/urethritis
P - pharm: alpha agonist (overflow), anti-cholinergic (overflow), pro-cholintergics (urge), EtOH, Caffeine
P -psychiatric
E -excess urine output - DM
R - restricted mobility
S - stool impaction

GAM (27 decks)

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