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Urology > Urinary incontinence > Flashcards

Urinary incontinence Flashcards

1
Q

Nl bladder fx should

A

Store LRG volumes of UA at low pressures

Empty bladder completely

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2
Q

Continence is dependent on

A

Compliant reservoir

Efficent sphincter

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3
Q

Efficent sphincter Req two components

A
  1. Involuntary smooth muscle of bladder neck

2. Voluntary sk muscle of external sphincter

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4
Q

F- RFs of incontinence

A 
Obesity
Age
Multiparity
Vaginal Delivery
Fam Hx
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5
Q

M- RFs of incontinence

A 
Age
Prostate Dz
UTI Hx
Constipation
DM
Neuro Dz
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6
Q

Urinary incontinence classified as

A

Transient - reversible

Established - low GU tract patho or age-related physiology

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7
Q

Transient incontinence causes

A

DIAPPERS

  • delerium
  • infection (symptomatic UTIs)
  • atrophic vaginitis/urethritis
  • Pharm - Rx
  • psychologic factors
  • excess UO
  • restricted mobility
  • stool impaction
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8
Q

MC transient cause in admitted pts - and other -

A

Delirium

-stool impaction

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9
Q

MC transient Rx causes

A 
Diuretics
Anticholinergics
Psychotropics
Opioids
Alpha-blks (F)
Alpha-agonist (M)
CCB
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10
Q

Incontinence established causes

A

Detrusor overactivity (urge Incontinence)

Urethral incompetence
(Stress Incontinence)’

Urethral instruction

Detrusor underactivity (overflow Incontinence)’

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11
Q

Types of urinary Incontinence

A

Total Incontinence
Stress Incontinence
Urge Incontinence
Overflow Incontinence

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12
Q

Total Incontinence is?

A

Urinary loss at all times and in all positions - aka continuous incontinence

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13
Q

Total Incontinence is due to?

A

Anatomic ABNLs

  • Lost sphincter efficiency
  • Fistulas 2/2 pelvic/vag surgery or diverticulitis
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14
Q

TXT Total Incontinence

A

Surgery

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15
Q

Total Incontinence Hx

A
  • Leakage degree
  • Relation to activity
  • Position/fullness of bladder
  • Timing of onset
  • progression
  • PMH/PSH/Rx/OB hx
  • supplements
  • voiding Diary
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16
Q

Total Incontinence PE

A

GU - pelvic exam
GI - rectal exam
Neuro Exam
Bladder stress test

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17
Q

What is a stress test for the bladder?

A

Pt stands and coughs w/ full bladder

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18
Q

Incontinence Labs W/U

A

UA-Cx > UTIs
BUN/creatinine > renal Fx
PSA

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19
Q

Incontinence Special tests?

A 
Post-void residual urine volume
Cystogram
Urodynamic studies (nit routine)
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20
Q

Purpose of Post-void residual urine volume test for Total Incontinence

A

Via urethral cath or U/S a PVR volume <50mL is NL

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21
Q

Purpose of cystogram for Total Incontinence

A

Evaluates fistulas or bladder neck for descent issues

22
Q

Purpose of urodynamic studies is?

A

Cystometry studies
Uroflow testing
(Not routine)

23
Q

What is stress incontinence?

A

Instant urine leakage in response to a stress maneuver

24
Q

stress incontinence is aka?

A

Urethral incompetence

25
Q

2nd MC cause if urinary incontinence in older women?

A

Stress incontinence

26
Q

MC incontinence in men S/P radical prostatectomy?

A

Stress incontinence

27
Q

Stress incontinence can coexist w/? and is ass/w?

A

detrusor muscle over activity

  • Pelvic floor laxity
  • Poor vesicourethral sphincteric unit
28
Q

Stress incontinence leakage occurs the worse during?

A

the day

29
Q

Stress incontinence stress test result?

A

Positive

30
Q

Multiparous women, pelvic surgery and prostate surgery are all ass/w?

A
  • Pelvic floor laxity

- Poor vesicourethral sphincteric unit

31
Q

Stress incontinence TXT?

A

Kegal exercises
lifestyle mod - limit caffeine/fluid intake or weight loss
Pessaries or vaginal cones
Sling surgery

32
Q

Urge incontinence is

A 
Overactive bladder (detrusor over activity)
Urinary leakage after intense urge
33
Q

2/3 of geriatric incontinence is due to?

A

Urge incontinence

34
Q

Urge incontinence w. men MC ass/w?

A

urethral obstruction from BPH

35
Q

Sudden unexplained onset of Urge incontinence reqs?

A

Cystoscopy or urine cytology to R/O bladder stones/tumor

36
Q

Urge incontinence 1st line TXT?

A

Bladder training (scheduled voiding while gradually lengthening time between voids w/ relaxation techqniues)

37
Q

Urge incontinence other TXT?

A 
Lifestyle modifications (Wgt loss, caffeine reduction)
Timed/prompted voiding for cognitively impaired
Kegal exercises
38
Q

Urge incontinence Rx TXT?

A

Antimuscarinics 1st (SEs- delirium, dry mouth, retention)
-Solifenacin
-Oxybutynin
-Fesoterodine
-Tolterodine
2nd - Antispasmodic (SEs- less dry mouth, Cardiac efx)
3rd - Onabotulinum toxin A - inject detrusor muscle

39
Q

Least common incontinence

A

Overflow incontinence

40
Q

Overflow incontinence is usually due to?

A

Idiopathic or Sacral LMN dysfx

Somtimes chronic urinary retention (over-distended bladder)

41
Q

Overflow incontinence S/S

A

Urinary frequency
Nocturia
Freq leakages of small volumes

42
Q

Overflow incontinence postvoiding residual urine volume?

A

> 450mL

43
Q

Overflow incontinence TXT

A

Augmented voiding techniques
- double voiding/suprapubic pressure
Intermittent or indwelling cath

44
Q

Urethral obstruction is usually due to?

A

BPH
Urethral stricture
Bladder neck contacture
Prostatic cancer

45
Q

What is a common cause of established urinary incontinence in older men?

A

Urethral obstruction

46
Q

Urethral obstruction S/S

A 
Post-void dribbling
Urge incontinence-(2/3 pts coexist detrusor overactive)
Overflow incontinence (obstuct > retain > overflow)
47
Q

Urethral obstruction TXT

A

Relieve obstruction

  • surg decompress (most effective -esp retain/BPH)
  • intermittent/indewlling cath (non-op UA retain)
  • A-blks (Terazosin, prazosin, tamulosin)
48
Q

General TXT strategies

A 
Kegal exercises
Wgt loss
Reduce fluids, caffeine, ETOH, Tob cessation
no evening fluids
TXT constipation
TXT pulm Dz (PVT valsalva coughs)
Pads/briefs
49
Q

Kegel exercise how to

A 
squeeze pelvic floor muscles
hold 3 seconds/release 3 seconds
RPT 10x
Each week, add 1 second until 10 seconds each time
Work up to 3 sets everyday
50
Q

Best tool for evaluating incontinence?

A

bladder/voiding diary

Urology (7 decks)

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