Urinary incontinence Intro Flashcards
classification of urinary incontinence based on sxs?
Stress urinary incontinence Urge urinary incontinence Mixed incontinence Unaware (unconscious) incontinence Nocturnal enuresis Continuous incontinence
classification of urinary incontinence based on underlying path?
Intrinsic sphincteric deficiency (ISD) Urethral hypermobility Detrusor overactivity Low bladder compliance Urinary retention
what are transient causes of UI?
"DIAPPERS" Delirium Infection Atrophic vaginitis Pharmaceuticals/Polypharmacy Psychological Excessive urine production Restricted mobility Stool impaction/constipation
what history Q’s should you ask for UI eval?
Precipitating factors (Cough/laugh/strain. movement, EtOH, caffeine, constipation, immobility)
Amount (pads/day)
Urinary symptoms
urologic hx (UTI’s, STDs, surgery)
neurological conditions (CVA, parkinson’s, MS, spinal disk dz)
meds (furosemide)
what is included in a PE for UI eval?
Female: pelvic exam Male: prostate exam Perineal sensation Rectal exam: stool impaction, bulbocavernosal reflex Lower extremities: edema
what is included in a female pelvic exam for UI eval?
Vaginal epithelium: atrophic vaginitis
Cotton swab test (cotton swab in urethra, change of 30 degrees or more w/ strain indicates urethral hypermobility)
Cough test (stress UI)
studies for UI eval?
UA, culture: glucosuria, infx
Voiding diary (voids, incontinence, fluid consumption, BM’s)
Post-void residual: retention
Cystoscopy: stricture, tumor
Urodynamic study
imaging for UI eval?
voiding cystourethrogram pelvic imaging (MRI) neurologic directed imaging
tx for DIAPPERS
Delirium: tx cause (circadian, pain)
Infx: abx
Atrophic vaginitis: topical vaginal estrogens placed around urethra
Pharmaceuticals: elimination/adjustments
Psych: Psych referral
Excessive urine output: Tx/management of cause (DM, CHF, etc), alter timing of fluid intake/diuretics, elevation of LE
Restricted mobility: bedside commode, urinal
Stool impaction/constipation: bowel management
Tx for UI and urinary retention
Avoidance of certain OTC medications and prescription meds
Catheterization
BPH medication, surgery
What are some tx options for female SUI?
noninvasive: behavioral, meds, continence device
Minimally invasive: bulking agents
Surgical
What surgical procedures are available for female SUI?
Anterior repairs
Suspensions
Artficial Urinary Sphincter
Sling procedures
What behavioral therapy can be done to help with female SUI?
Activity modification Voiding diary Timed voiding Bladder training Pelvic floor muscle training (PFMT) Fluid intake modification Dietary modification Weight loss Avoidance of constipation Elevation of edematous lower extremities
What medications can be used for female SUI?
alpha agonists
Duloxetine
What are some continence device that can be used for female SUI?
pessary
indwelling cath
urethral occlusive device
How can bulking agents be used for female SUI?
injection of material adjacent to prox. urethral/bladder neck
coapts urethral mucosa
increased bladder outlet resistance
multiple tx may be needed
Surgical options for female SUI?
anterior repair
suspesion
artificial urinary sphincter
sling
what are the 3 parts of artificial urinary sphincter sx?
cuff
reservoir
pump
describe the cuff of an artificial urinary sphincter in men and women
M: Perineal approach, encircles urethra
W: Transvaginal or transabdominal approach, placed at bladder neck
describe the pump of an artificial urinary sphincter in men/women
M: placed in scrotum
will tend to move upward, to a position too high to operate easily
Pt instructed to pull downward on pump daily to prevent encapsulation in high position
W: placed in labia majora
how long is the cuff left in the open position (deactivated?
x6 wks postop (healing w/o urethral pressure) —> return in 6wks for activation/instruction
artificial urinary sphincter: what should you always remember to do before placing a urinary catheter?
deactivate device (pump and lock into open position)
Artificial urinary sphincter: s/s and complications of infection
First 2 months Pain, edema, erythema near pump or cuff Leukocytosis, fever E. coli or Staph Explantation, Abx
Artificial urinary sphincter: s/s and complications of infection
Prevention: avoid harsh perineal pressure
MC if pelvic radiation
S/Sx: dysuria, hematuria, recurrent infections
Explantation
Re-implant >3 months later
