Urinary Incontinence

Question 1

loss of urine four to five times each day, typically occurring immediately after coughing, sneezing, or heavy lifting

What Type of Incontinence  is it?• 
A.  Genuine Stress Incontinence• 
B.  Urge Incontinence• 
C.   Overflow Incontinence• D.   Mixed Incontinence• 
E.   D-I-A-P-P-E-R-S REVERSIBLE

Answer 1

A. Genuine Stress Incontinence•

Question 2

Overflow incontinence A/S

Answer 2

diabetes mellitus, spinal cord injuries, Pelvic Sx. or lower motor neuropathies

Question 3

Reversible D-I-A-P-E-R-S Incontinence

Answer 3

Delirium, Infection, Atrophic Vaginitis, Psychological, Excess Fluid States, Restricted Mobility, Stool Impaction

Question 4

53 year old patient presents to your office complaining of loss of urine for the past 6 months. She is unsure when she leaks but it does not seem to occur when she coughs or sneezes. She denies urgency and she does not dribble urine all the time. She never had children and she has never had surgery. She states she has always had severe Hot Flushes since she went into menopause two years ago. Her physical exam is remarkable of severe atrophic vaginitis with atrophy. A midstream voided urinalysis is normal. WHAT TYPE OF INCONTINENCE IS IT?

Answer 4

Reversible D-I-A-P-P-E-R-S Incontinence

Question 5

Urgency Incontinence d/d

Answer 5

Cystitis, stones, diverticula, contracted bladder, vesical neoplasms, suprasegmental, neurogenic lesions

Question 6

Stress incontinence D/D

Answer 6

• Defective urethral sphincter
• Funneling of vesical neck
• flattening of urethrovesical angle
• post-op fixation

Question 7

Overflow incontinence d/d

Answer 7

• Obstruction (Post-op, tumor, psych)
• Neurogenic
• lesions

Question 8

Total incontinence

Answer 8

• congenital causes (epispadia)

- fistulas

Question 9

Involuntary loss of GUSI

Answer 9

• With normal bladder neck support, increased intra-abdominal pressure compresses proximal urethra.
• With loss of normal bladder neck support, increased intra-abdominal pressure increases bladder pressure without compressing proximal urethra

Question 10

Urodynamic protocol

Answer 10

• May be used to distinguish GUSI from URGE in patients who
• empty bladder, UA, and catheterization for esidual
• Measure volumes for first sensation, fullness, + maximal capacity
• Remove catheter + Observe meatus during coughing; If no spurt, repeat standing + w/ Q-tip test

Question 11

Cystocele A/S ___ incontinence

Answer 11

GUSI

Question 12

Sx for Normal pressure urethra in mobile patietns

Answer 12

• Sling/TVT

- Buirch RPU

Question 13

Sx Immobile low pressure urethra Pts

Answer 13

Urethral Bulking

Question 14

Pharm Incontinence

Answer 14

GUSI: Duloxitine

OAB/UUI: Oxubutinin, Tolterodine, Trospium, Imipramine