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Fdnts 3 Exam 1 > Urinary incontinence Intro > Flashcards

Urinary incontinence Intro Flashcards

1
Q

classification of urinary incontinence based on sxs?

A 
Stress urinary incontinence
Urge urinary incontinence
Mixed incontinence
Unaware (unconscious) incontinence
Nocturnal enuresis
Continuous incontinence
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2
Q

classification of urinary incontinence based on underlying path?

A 
Intrinsic sphincteric deficiency (ISD)
Urethral hypermobility
Detrusor overactivity
Low bladder compliance
Urinary retention
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3
Q

what are transient causes of UI?

A 
"DIAPPERS"
Delirium
Infection
Atrophic vaginitis
Pharmaceuticals/Polypharmacy
Psychological
Excessive urine production
Restricted mobility
Stool impaction/constipation
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4
Q

what history Q’s should you ask for UI eval?

A

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)

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5
Q

what is included in a PE for UI eval?

A 
Female: pelvic exam
Male: prostate exam
Perineal sensation
Rectal exam: stool impaction, bulbocavernosal reflex
Lower extremities: edema
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6
Q

what is included in a female pelvic exam for UI eval?

A

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)

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7
Q

studies for UI eval?

A

UA, culture: glucosuria, infx

Voiding diary (voids, incontinence, fluid consumption, BM’s)

Post-void residual: retention

Cystoscopy: stricture, tumor

Urodynamic study

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8
Q

imaging for UI eval?

A 
voiding cystourethrogram
pelvic imaging (MRI)
neurologic directed imaging
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9
Q

tx for DIAPPERS

A

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

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10
Q

Tx for UI and urinary retention

A

Avoidance of certain OTC medications and prescription meds

Catheterization

BPH medication, surgery

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11
Q

What are some tx options for female SUI?

A

noninvasive: behavioral, meds, continence device

Minimally invasive: bulking agents

Surgical

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12
Q

What surgical procedures are available for female SUI?

A

Anterior repairs

Suspensions

Artficial Urinary Sphincter

Sling procedures

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13
Q

What behavioral therapy can be done to help with female SUI?

A 
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
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14
Q

What medications can be used for female SUI?

A

alpha agonists

Duloxetine

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15
Q

What are some continence device that can be used for female SUI?

A

pessary

indwelling cath

urethral occlusive device

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16
Q

How can bulking agents be used for female SUI?

A

injection of material adjacent to prox. urethral/bladder neck

coapts urethral mucosa

increased bladder outlet resistance

multiple tx may be needed

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17
Q

Surgical options for female SUI?

A

anterior repair

suspesion

artificial urinary sphincter

sling

18
Q

what are the 3 parts of artificial urinary sphincter sx?

A

cuff
reservoir
pump

19
Q

describe the cuff of an artificial urinary sphincter in men and women

A

M: Perineal approach, encircles urethra

W: Transvaginal or transabdominal approach, placed at bladder neck

20
Q

describe the pump of an artificial urinary sphincter in men/women

A

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

21
Q

how long is the cuff left in the open position (deactivated?

A

x6 wks postop (healing w/o urethral pressure) —> return in 6wks for activation/instruction

22
Q

artificial urinary sphincter: what should you always remember to do before placing a urinary catheter?

A

deactivate device (pump and lock into open position)

23
Q

Artificial urinary sphincter: s/s and complications of infection

A 
First 2 months 	
Pain, edema, erythema near pump or cuff
Leukocytosis, fever
E. coli or Staph
Explantation, Abx
24
Q

Artificial urinary sphincter: s/s and complications of infection

A

Prevention: avoid harsh perineal pressure
MC if pelvic radiation
S/Sx: dysuria, hematuria, recurrent infections
Explantation
Re-implant >3 months later

25
Q

What is urge incontinence?

A

episodic involuntary loss of urine, immediately preceded by/associated with urgency

26
Q

What is overactive bladder?

A

Urinary urgency, usually associated with frequency

27
Q

What are the non-invasive tx options for urge incontinence/overactive bladder?

A

Behavioral Therapy
Estrogen
Anticholinergic medication
Beta adrenergic medication

28
Q

Minimally invasive options for Urge Incontinence and Overactive Bladder?

A

Neuromodulation (Sacral, Tibial)

Botulinum

29
Q

Surgical options for urge incontinence/overactive bladder?

A

Augmentation enterocystoplasty
Autoaugmentation
Urinary diversion

30
Q

who is estrogen therapy used for?

A

post menopausal women

gel placed in vagina

31
Q

How do anticholinergics help with urge incontinence/overactive bladder?

A

decrease detrusor muscle contractions

32
Q

ADEs of anticholinergics?

A

xerostomia, constipation, dizziness, drowsiness, blurry vision, h/a

33
Q

contraindications for anticholinergics?

A

uncontrolled narrow angle glaucoma, myasthenia gravis, intestinal obstruction, gastric retention, urinary retention

34
Q

What anticholinergics may be used?

A

oxybutynin

Tolterodine

others: Fesoterodine
Darifenacin
Solifenacin
Trospium

35
Q

What beta adreneric agonist may be used for UI and OAB? MOA?

A

MIrabegron

Stimulates Beta-3 receptors in bladder

Incr c-AMP, decr intracellular calcium >

Relaxation of detrusor

36
Q

Where is botulin toxin injected? how long is it effective for?

A

cystoscopically into detrusor

3-12 months

37
Q

Describe sacral neuromodulation

A

Electrical stimulation of S3 afferent nerve to modify voiding reflex

38
Q

Describe Posterior Tibialis Nerve Stimulation (PTNS)

A

in office procedure
Electrode placed superior to and posterior to medial malleolus of either leg

Electrical stimulation x 30 min weekly for 12 weeks

39
Q

Describe augmentation enterocystoplasty surg

A

works in increased bladder capacity

bladder dome is open > recruit intestinal segment > decreased incontinence

40
Q

Describe autoaugmentation

A

destrusor muscle of dome of bladder is incisied, bladder capacity expands

41
Q

Describe urinary diversion

A

urine bypasses bladder via e.g. ileal conduit

Fdnts 3 Exam 1 (17 decks)

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