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Clin Med3: Womens Health > urinary incontinence - anne > Flashcards

urinary incontinence - anne Flashcards

1
Q

what are the presentations of urinary incontinence

A

near constant dribbling or intermittent voiding
extreme urgency
occurs/worsens with intra-abdominal pressure
postvoid dribbling
family reports smell of urine
pt engages in “bathroom mapping”

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2
Q

what is urge incontinence

A

most common type in older people
uncontrolled urine leakage after urgent need to void
nocturia/nocturnal incontinence common
precipitated by use of diuretic
exacerbated by inability to quickly reach bathroom
atrophic vaginitis in women

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3
Q

what is stress incontinence

A

2nd most common in women
urine leakage due to increase intra-abdmonial pressure
leakage volume low to moderate
men: post surgical
more severe in obese pts

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4
Q

what is overflow incontinence

A

2nd most common type of incontinence in men
dribbling of urine from overly full bladder
volume usually small, but leaks may be constant

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5
Q

what is functional incontinence

A

urine loss due to cognitive or physical impairments or environmental barriers that interfere with control of voiding

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6
Q

what is mixed incontinence

A

any combination of other types of incontinence

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7
Q

what is the pathophysiology of urinary incontinence in post menopausal women

A

decreased estrogen leads to atrophic urethritis/vaginitis, decreased urethral resistance and closure pressure

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8
Q

what is the pathophysiology of urinary incontinence in men

A

prostate size increases, partially obstructing urethra leading to incomplete bladder emptying and strain on detrusor muscle; facilitate incontinence but do not cause it

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9
Q

what is the pathophysiology of urinary incontinence in younger patients

A

often begins suddenly, may cause little leakage and usually resolves quickly with little or no treatment

once cause in younger patients but several in older adults

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10
Q

What is transient incontinence

A

“diappers”
Delirium
Infection
Atrophic urethritis and vaginitis
pharmaceuticals
Psychiatric disorders
Excess urine output
Restricted mobility
Stool impaction

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11
Q

What is established incontinence

A

caused by persistent problem affecting nerves or muscles

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12
Q

what are the mechanisms of estbalished incontinence

A

bladder outlet incompetence or obstruction
detrusor overactivity or under-activity
detrusor-sphincter dyssynergia
combination

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13
Q

What is outlet incompetence

A

common cause of stress incontinence
in women, weakness of pelvic floor from multiple vaginal deliveries, pelvic surgery, age-related changes, or combo

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14
Q

what is outlet incompetence in men

A

common cause is damage to sphincter or to bladder neck and posterior urethra after radical prostatectomy

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15
Q

What is outlet obstruction

A

common cause in men
both sexes: fecal impaction
women: previous surgery for incontinence, prolapsed cystocele

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16
Q

what can obstruction lead to

A

chronically over distended bladder - loses ability to contract - does not empty completely resulting in overflow

detrusor overactivity and urge incontinence; detrusor muscle loses ability to contract

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17
Q

What is detrusor overactivity

A

common cause of urge incontinece in older and younger
idiopathic of dysfunction of frontal micturition inhibitory center or outlet obstruction
detrusor overactivity with impaired contractility

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18
Q

what is overactive bladder

A

described urinary urgency (with or without incontinence) often accompanied by urinary frequency and nocturia

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19
Q

what can cause detrusor underactivity

A

injury to spinal cord or nerve roots supplying bladder, periphaeral/autonomic neuropathies, other neurological disorders

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20
Q

what are the casues of detrusor underactivity in men

A

detrusor replaced by fibrosis and connective tissue with chronic outlet obstruction

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21
Q

what can cause detrusor under-activity in women

A

usually idiopathic

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22
Q

what is detrusor-sphincter dyssynegria

A

loss of coordination between the bladder contraction and external urinary sphincter relaxation; outlet obstruction with resultant overflow incontinence

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23
Q

what is dyssynegria

A

often due to spinal cord lesion that interrupts pathways to pontine micturation center
-causes severe trabeculation, diverticula, “christmas tree” deformation of bladder (cystogram)

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24
Q

what causes “christmas tree” deformation of the bladder

A

Dyssynergia

25
Q

What needs to be excluded before treatment of urinary incontinence

A

urinary retention

26
Q

what history is needed for the workup of incontinence

A

duration and patterns of voiding
bowel function
drug use
obstetric and pelvic surgical history

27
Q

what needs to be assessed with physical exam for incontinence

A

neurological
pelvic
rectal exams are focus

28
Q

what are tests used for urinary incontinence

A

urinalysis, urine culture
serum BUN, creatinine
post void residual volume
~urodynamic testing

29
Q

what tests are required for urinary incontinence workup

A

UA, UCX, BUN and serum creatinine

30
Q

what is normal post void residual volume

A

<50ml,
<100mg is usually acceptable for >65yo

31
Q

what is a postvoid residual volume of >200ml suggestive of

A

detrusor underactivity or oulet obstruction

32
Q

how can postvoid residual volume be measured

A

Catheterization or US

33
Q

when is urodynamic testing indicated

A

when clinical eval and appropriate tests are not diagnostic or when abnormalities must be precisely characterized before surgery

34
Q

What is urodynamics

A

term for all-encompassing series of tests and procedures regarding the lower urinary tract.

35
Q

what is cystometrogram

A

testing bladder function, pressure and volume

36
Q

what is electromyography

A

recording of electrical activity within muscle tissue

37
Q

what is urethral pressure profile

A

measuring the balance of pressure along urethra

38
Q

what your uroflowmetry

A

testing of volume of urine released from the body

39
Q

what is pressure flow study

A

measuring the bladder pressure required to urinate and generated flow rate

40
Q

what is peak urinary flow rate testing used for

A

flow meter used to confirm of exclude outlet obstruction in men

41
Q

what is cystometry/cystometrography(CMG)

A

pressure-volume curves and bladder sensation recorded while bladder is filled with sterile water; provocation testing used to stimulate bladder contractions

42
Q

what is electromyography of perineal muscles used for

A

assess sphincter innervation and function

43
Q

what is pressure-flow video studies

A

usually done with voiding cystourethrography; correlates bladder contraction, bladder neck competency and detrusor-sphincter synergy; not widely available

44
Q

what are general treatment of urge incontinence urinary incontinence

A

limit fluid intake at certain times
avoid fluids that irritate bladder (caffeine)
drink 48-64 oz of fluid a day
assistance for restricted mobility or cognitive impairments

45
Q

what are bladder training treatments for urge incontinence urinary incontinence

A

times voiding (every 2-3 hours) while awake
prompted voiding for cognitively impaired
voiding diary helps establish how often and when voiding is indicated

46
Q

what are the most common drugs used for urge incontinence urinary incontinence

A

oxybutynin and tolterodine

47
Q

when is immediate-release oxybutynin used

A

prophylactic if incontinence occurs at predictable times

48
Q

what is sacral nerve stimulation used for urinary incontience

A

sever urge incontinence refractory to other treatments
it is a implanted neurostimulator

49
Q

what is posterior tibial nerve stimulation (PTNS)

A

application of low-voltage stimulation in 30 minute sessions Q weekly for 10-12 weeks

50
Q

when is surgery indicated for urge incontinence urinary incontinence

A

last resort usually younger patients with severe urge incontinence refractory to other treatments

51
Q

what is the most common surgical procedure for urge incontinence urinary incontinence

A

augmentation cystoplasty

52
Q

what is the treatment for stress incontinence

A

behavioral
-bladder training, kegel exercises, avoid physical stress that provoke incontinence, losing weight, exercise using vaginal cones

53
Q

what are drugs that are used for stress incontinence

A

psudophedrine: women with outlet incompetence
imipramine, duloxetine: mixed stress and urge incontinence or stres alone

54
Q

what is the treatment for stress incontinence if use to atrophic urethritis

A

topical estrogen

55
Q

what are surgery and devices used to treat stress incontinence urinary incontinence

A

non-invasive treatments ineffective
occlusive devices

56
Q

what are treatment options for outlet obstruction

A

BPH or CA: drugs or surgery
urethral structure: dilation or stenting
cystoceles: surgery or reduced with pessary
alternatives: electrical stimulation, cholinergic agonist bethanechol

57
Q

what are treatment options for overflow incontinence-detrusor under activity

A

bladder decompression or self cath, double voiding, valsalva maneuver, application of suprapubic pressure
complete acontractile detrusor: requires intermittent self-cath or use of indwelling catheter

58
Q

what are the four types of urinary incontinence

A

urge, stress, overflow, functional

Clin Med3: Womens Health (13 decks)

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