Urinary symptoms

Question 1

what is interstitial cystitis?

Answer 1

bladder pain syndrome

syndrome of having urinary urgency and increasing pelvic pain and pressure that is relieved with voiding

Question 2

who gets interstitial cystitis?

Answer 2

more common with women and associated with psychiatric and pain disorders (fibromyaglia)

See dyspareunia, urinary frequency and urgency and symptoms relieved with voiding and pain with bladder filling

Question 3

Diagnosis of interstitial cystitis?

Answer 3

bladder pain with no other cause >6 weeks and normal urinalysis

Question 4

Treatment of interstitial cystitis

Answer 4

not curative, but focus on improving quality of life. Behavioral modification and avoidance of triggers, physical activity and amitriptyline, pentosan and polysulfate sodium
analgesics for acute exacerbations.

Question 5

What does pentosan polysulfate sodium do?

Answer 5

repairs the urothelium and has minimal side effects (mild reversible hair loss) and approved by FDA for treatment of interstitial cystitis or bladder pain syndrome.

Question 6

What do we do for refractory cases

Answer 6

bladder instillation therapy or intradetrusor botulinum toxin or sacral neuromodulation

Question 7

cystocele symptoms and definition

Answer 7

this is pelvic organ collapse that creates a bulge sensation that may have associated stress urinary incontinence due to loss of anterior vaginal wall support.

Question 8

neurogenic bladder cause and presentation

Answer 8

chronic urinary retention due to peripheral neuropathy (DM2) and impaired detrusor contractiligy and decreased sensation of bladder filling cause of incomplete bladder emptying

Question 9

presentation of neurogenic bladder

Answer 9

see constant dribbling from urine overflow. see no associated pelvic pain

Question 10

non gonococcal urtheritis presentation

Answer 10

presents with urinary frequency, urethral tenderness, sterile pyuria (elevated WBC on urinalysis and negative urine culture) and this is associated with atypical bacteria like CHlamydia trachomatis or mycoplasma genitalium.

These pts also have associated cervicitis (post coital bleeding, cervical motion tenderness and pain with voiding)

Question 11

urgency incontinence is also called

Answer 11

overactive bladder

Question 12

overactive bladder can cause

Answer 12

involuntary detrusor contractions with immediate loss of urine.

Question 13

non pharmacological treatment of urinary incontinence

Answer 13

wt loss in overweight pts
dietary changes (lower ETOH and fluid and caffeine intake
smoking cessation
stopping offending medications and diuretics

Question 14

behavioral therapy for urinary continence

Answer 14

bladder training (urge and mixed incontinence)
timed voiding
voiding diary
relaxation techniques
pelvic floor (kegal exercises)

Question 15

which types of urinary incontinence are treated with Kegel exercises?

Answer 15

urge, stress and mixed incontinence

Question 16

when do we use incontinence pessary?

Answer 16

for pts who fail conservative therapy (devices have compliance rate of about 50% but helpful in ppl who want to avoid surgery

Question 17

surgery for stress incontience

Answer 17

highest cure rate and mid urethral sling or Burch retropubic colposuspension

only for people who fail conservative tx

Question 18

when do we get urodynamic testing

Answer 18

helps to diagnose people who have mixed symptoms (stress or urgency)

Question 19

what is urodynamic testing?

Answer 19

measures urine storage and evacuation and helps to diagnose incontinence type with mixed symptoms.

Not well standardized and has inconsistent reproducible results in same pt.

Question 20

urinary retention is defined with:

Answer 20

bladder ultrasound showing more than >300 ml in volume

Question 21

treatment of urinary retention

Answer 21

urinary catherization

Question 22

what can cause acute urinary retention in a elderly?

Answer 22

underlying BPH,
sympathomimetics (pseudophedrine),
anithistamines with anticholinergic properties (diphenydramine)
cold medications

Question 23

What causes the pathophysiology behind acute urinary retention?

Answer 23

urinary retention with increased bladder tension can stimulate sympathetic nervous system and result in catecholamine release and delirium.

Can have agitation and confusion without abdominal discomfort