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Summer FDTN Exam 1 > Urinary incontinence > Flashcards

Urinary incontinence Flashcards

1
Q

What is urinary incontinence

A

Involuntary loss of urine

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2
Q

What are the types of urinary incontinence

A

MC: Stress, Urge, Mixed
Unaware
Nocturnal enuresis
Continuous

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3
Q

How can urinary incontinence be classified based on pathophys

A 
intrinsic sphincter deficiency 
urethral hypermobility 
detrusor overactivity 
low bladder compliance 
urinary retention
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4
Q

Transient causes of urinary incontinence include

A 
Delirium 
Infection 
Atrophic vaginitis 
Pharmaceuticals 
Psych 
Excess urine production 
Restricted mobility 
Stool impaction
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5
Q

When taking a urinary incontinence H&P, it is important to ask

A

Precipitating factors (cough, laugh, movement, caffeine, EtOH, constipation, immobility)
Amount in pads x day
Urinary Sx
GPA
Uro Hx (STI, UTI, strictures, surgeries)
Neuro conditions (CVA, parkinson/s, MS, spinal disc dz)
Fluid consumption (amt, type, time)
Meds (Furosemide?)

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6
Q

What should you do on PE for urinary incontinence complaint

A

Pelvic/Prostate exam
Perineal sensation
DRE (impaction. bulbocavernosal reflex)
Check for LE edema

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7
Q

What are the 3 components of a female pelvic exam

A
  1. Vaginal epithelium for atrophic vaginitis
  2. Cotton swab text for hypermobility (cotton swab in urethra; change 30+ degrees is abn)
  3. Cough test
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8
Q

What studies can you do when assessing urinary incontinence

A 
UA, culture 
Voiding diary (for voids, consumption, bowel movements) 
Post void residual (for retention)
Cytoscopy (for strictures or tumor) 
Urodynamic study
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9
Q

What imaging can you get for urinary incontinence

A

Voiding cystourethrogram
Pelvic MRI
Neuro imaging

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10
Q

How do you treat urinary incontinence based on cause

A 
Delirium: underlying cause
Infx: abx 
Atrophic vaginitis: topical estrogen periurethrally
Pharm: eliminate or adjust 
Psych: refer to psych 
Excess UO: manage DM, CHF, etc. alter time of fluid intake
Reduced mobility: bedpan, urinal
Stool impaction: bowel management
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11
Q

Treatment to empty bladder includes

A

Avoid meds that cause retention
Catheterization
BPH meds, surgery

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12
Q

What do you do if you suspect continuous incontinence (or vesicovaginal fistula)

A 
Pyridium test (drink pyridine, insert tampon, see if it fills orange) 
Surgery
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13
Q

Tx for female stress incontinence includes (general)

A

NON-invasive: Behavioral therapy, Meds, Continence devices
Min. invasive: Bulking agents
Surgical: anterior repairs, suspensions, AUS, sling

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14
Q

What is included in behavioral therapy

A 
activity modification 
voiding diary
timed voiding (empty bladder before leakage)
pelvic floor muscle training 
fluid intake modification (not at night) 
diet modification (no caffeine, EtOH, spicy, acidic) 
weight loss (decrease intra-abd pressure) 
avoid constipation 
elevate edematous LE (mobilize fluid, void before sleeping- compression stockings)
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15
Q

What is pelvic floor muscle training

A

Good for SUI, UUI, and mixed UI

Contract muscles for 6-8 seconds 10 times, TID

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16
Q

What meds aid in treating SUI

A 
Alpha Agonists (Pseudoephedrine, ephedrine, imipramine)
Duloxetine (SNRI)
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17
Q

How do alpha agonists Tx SUI

A

Increase muscle tone of urinary sphincter (not FDA approved)
CI in cardiac dz, uncontrolled HTN, DM, MAOI, Sz risk, glaucoma (narrow angle), amd hyperthyroid

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18
Q

What are ADE of Duloxetine (SNRI)

A

Nausea

Suicide

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19
Q

What continence devices can be used to Tx SUI

A 
Pessary 
Indwelling catheter (urethral or suprapubic)
20
Q

What are bulking agents

A

Collagen, silicone, graphite, and calcium hydroxyapatite
Injected adjacent to proximal urethra (bladder nec)
Coapts urethral mucosa and increases bladder outlet resistance
Can be done transurethrally, but ned a few Tx

21
Q

What should you be cautious with when giving bulking agents

A

Do skin test to check for allergic Rxn

Can migrate to into lymphatics- calcium visible on XRays

22
Q

What is an anterior repair (Tx for SUI)

A

Pubocervical fascia is overlapped posteriorly to support bladder

23
Q

What are the types of suspension surgery to Tx SUI

A

Marshall-Marchetti-Krantz (MMK)- periurethral

Burch- peruvesical

24
Q

What is a sling (Tx for SUI)

A

a “hammock” under the urethra, autologous fascia sling

Can be allograft, Xenograft (bovine, porcine), or synthetic

25
Q

What can happen if a sling is over corrected

A

Urinary retention! may need intermittent catheterization

26
Q

Dangerous things to watch out for is patient has a bladder sling

A

Erosion into vagina;
Dyspareunia, vaginal pain/discharge/bleeding
Dysuria, hematuria, urgency, frequency, recurrent UTI

27
Q

What are the 3 parts of an AUS

A

Cuff
Reservoir (posterior to abdominal wall)
Pump (in labia majora or scrotum)

28
Q

Where is the cuff placed in men and women

A

M: perineal approach- encircles urethra
W: Transvaginal/abdominal approach- encircles bladder neck

29
Q

What is important to remember about the pump of an AUS in men

A

it tends to move up, so they should pull it down once per day to prevent encapsulation

30
Q

How do you place the cuff immediately after surgery

A

Leave it open (deflated, deactivated) for the first 6 weeks so it can heal w/o urethral pressure
After 6 weeks comeback and have it activated (inflated)

31
Q

What MUST you remember about all AUS

A

DEACTIVATE and LOCK prior to CATHETERIZATION!

32
Q

What are S/Sx of infection of AUS

A

MC in first 2 months- E. coli or Staph
pain, edema, erythema near pump or cuff
Leukocytosis, fever
Give abx!

33
Q

What are S/Sx of erosion of AUS

A

2/2 harsh perineal pressure
Dysuria, hematuria, recurrent infections
Remove, re-implant >3 mo later

34
Q

What is urge incontinence

A

Episodic involuntary loss of urine immediately preceded by urgency
Overactive bladder is urgency+frequency

35
Q

What is Tx for UUI (general)

A

NON-invasive: behavioral therapy, estrogen, anticholinergic, B-adrenergic
Min. invasive: neuromodulatora, botox
Surgical: augmentation, auto augment, urinary diversion

36
Q

Who can use estrogen as a UUI Tx, and how

A

Post-menopausal females
place peri-urethrally
CI if: PE, CVA, MI, cancer, DVT

37
Q

How do anticholinergics work

A

Inhibit muscarinic 3 receptors= decreased detrusor muscle contractions

38
Q

ADE of anticholinergics are

A

xerostomia, constipation, dizziness, drowsy, blurry vision, HA
CI: MG, intestinal obstruction, gastric or urinary retention, narrow angle glaucoma

39
Q

What are the anticholinergics

A

Oxybutynin (IR, ER, patch, or gel)
Tolterodine (IR, ER)
Also Fesoterodine, Darifenazin, Solifenacin, Trospium

40
Q

What is Mirabegron

A

Beta 3 agonist

Stimulates B3 in bladder= increased cAMP= decreased intracellular calcium= relax bladder and allow more filling

41
Q

What must you monitor if taking Mirabegron

A

BP!

1x week for the first 4 weeks

42
Q

How do you use botox as an UUI Tx

A

Inject cytoscopically into detrusoe

effects last 3-12 months

43
Q

What is Interstim

A

Sacral neuromodulator
Electrically stim. S3 afferent nerve to modivy voiding reflex
2 week trial: Place electrode near S3 curve, connect to generator belt, activate
If that trial goes well, have an internal generator placed

44
Q

What is Posterior tibialis nerve stimulation

A

In office procedure!
Electrode placed superior and posterior to medial malleolus of leg
Electrical stimulation x 30 min for 12 weeks

45
Q

What is Augmentation enterocystoplasty

A

Bladder dome is opened and detubularized intestine is added to increase size of bladder
Decreased intravesical voiding pressure and incontinence

46
Q

What is autoaugmentation

A

Detrusor of dome is incised, but urothelium kept intact (inner lining)
Bladder capacity expands and intravesical pressure lowers
Decreased incontinence

47
Q

What is urinary diversion

A

Ileal conduit- urine bypasses bladder

Summer FDTN Exam 1 (12 decks)

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