Voiding Dysfunction

Question 1

How does the micturition reflex get triggered?

Answer 1

Bladder half full, stretch, S2/3 increased parasympathetic, relaxation of the internal sphincter, and the brain also gets a signal the pons can override the reflex.

Question 2

Urge incontinence?

Answer 2

Overactive bladder - detrusor is uninhibited - frequent urge

Question 3

Stress incontinence?

Answer 3

Overwhelming the sphincter with increased abdominal pressure

Question 4

Mixed?

Answer 4

Both mixed and stress

Question 5

Overflow incontinence?

Answer 5

Blockage of flow - outlet obstruction, or loss of detrusor muscle like in neurogenic bladder, urine leaks through the sphincter.

Question 6

Causes of incontinence

Answer 6

Damage to pelvic floor (child birth, surgeries), MS, Diabetes, Parkinson’s, Fowler’s syndrome, prolapse, tumour, BPH

Question 7

Investigation for urinary complaint?

Answer 7

Urinalysis, culture, BUN, Cr, glucose and calcium

Post void residual volume, urodynamic testing, cystometry, bladder diary

Question 8

Lifestyle changes for incontinence?

Answer 8

Limit fluid intake 3-4 hours before bed, limit caffeine, maintain hydration, use padded undergarments, adequate hydration, bladder retraining, kegels

Question 9

Drugs used to treat incontinence?

Answer 9

Imipramine, pseudoephedrine, oxybutynin, mirabegron, Botox

Question 10

Anti-muscarinic side effects

Answer 10

Can’t spit, can’t shit, can’t see, can’t pee, tachycardia, palpitations, confusion/delirium, flushing

Question 11

Surgical for stress incontinence?

Answer 11

Transvaginal tape - very effective, old one was Burch procedure.

Question 12

Signs and Sx of BPH

Answer 12

Strain with urinating, dribbling, hesitancy, dysuria, polyuria, weak stream

Question 13

Tx for BPH

Answer 13

Can use AUA BPH score to decide on treatment - alpha antagonist, or 5 alpha reductase, or combo if more severe

TURP/ laser ablation

Question 14

International Prostate Symptom Scoring Tool

Answer 14

Measures the prostate symptoms

Question 15

PSA cut offs?

Answer 15

PSA >4, start being suspicious for prostate CA, could still be BPH, if it is very high (>10) it is ALWAYS prostate CA

Can look at Free PSA/ Total PSA - to help differentiate borderline high PSA

Question 16

Consider interstitial cystitis when?

Answer 16

Recurrent UTIs with no positive cultures, dysuria, pelvic discomfort

Question 17

Management for patients with urinary retention?

Answer 17

Foley catheter. Determine the cause. Can do a bladder scan to determine retention level , measure outputs

Question 18

Myrbetric function?

Answer 18

Relaxes the bladder - contains anticholinergic (blocks parasympathetic), increases beta adenergic system to decrease muscle contraction of the bladder (like fight or flight) makes more room.

Question 19

Oxybutrin

Answer 19

Anticholinergic - stops bladder muscle contractions

Question 20

Tolterodine

Answer 20

Muscaric antagonist - more selective for bladder less anticholinergic side effects

Question 21

Tamsulosin

Answer 21

Alpha 1 antagonists - for men to relax the muscles of the prostate and bladder neck to prevent urinary retention

Question 22

Finasteride

Answer 22

5 alpha reductase inhibitor - stops testosterone production so prostate don’t grow