Voiding Dysfunction Flashcards
How does the micturition reflex get triggered?
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.
Urge incontinence?
Overactive bladder - detrusor is uninhibited - frequent urge
Stress incontinence?
Overwhelming the sphincter with increased abdominal pressure
Mixed?
Both mixed and stress
Overflow incontinence?
Blockage of flow - outlet obstruction, or loss of detrusor muscle like in neurogenic bladder, urine leaks through the sphincter.
Causes of incontinence
Damage to pelvic floor (child birth, surgeries), MS, Diabetes, Parkinson’s, Fowler’s syndrome, prolapse, tumour, BPH
Investigation for urinary complaint?
Urinalysis, culture, BUN, Cr, glucose and calcium
Post void residual volume, urodynamic testing, cystometry, bladder diary
Lifestyle changes for incontinence?
Limit fluid intake 3-4 hours before bed, limit caffeine, maintain hydration, use padded undergarments, adequate hydration, bladder retraining, kegels
Drugs used to treat incontinence?
Imipramine, pseudoephedrine, oxybutynin, mirabegron, Botox
Anti-muscarinic side effects
Can’t spit, can’t shit, can’t see, can’t pee, tachycardia, palpitations, confusion/delirium, flushing
Surgical for stress incontinence?
Transvaginal tape - very effective, old one was Burch procedure.
Signs and Sx of BPH
Strain with urinating, dribbling, hesitancy, dysuria, polyuria, weak stream
Tx for BPH
Can use AUA BPH score to decide on treatment - alpha antagonist, or 5 alpha reductase, or combo if more severe
TURP/ laser ablation
International Prostate Symptom Scoring Tool
Measures the prostate symptoms
PSA cut offs?
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
Consider interstitial cystitis when?
Recurrent UTIs with no positive cultures, dysuria, pelvic discomfort
Management for patients with urinary retention?
Foley catheter. Determine the cause. Can do a bladder scan to determine retention level , measure outputs
Myrbetric function?
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.
Oxybutrin
Anticholinergic - stops bladder muscle contractions
Tolterodine
Muscaric antagonist - more selective for bladder less anticholinergic side effects
Tamsulosin
Alpha 1 antagonists - for men to relax the muscles of the prostate and bladder neck to prevent urinary retention
Finasteride
5 alpha reductase inhibitor - stops testosterone production so prostate don’t grow
