LOWER URINARY TRACT DISORDERS

Question 1

common in women and generally is treated successfully with a range of nonsurgical and surgical treatments

Answer 1

Urinary incontinence

Question 2

occurs with increases in abdominal pressure (such as coughing, running, lifting) and can be treated with pelvic muscle exercises, vaginal devices, lifestyle changes, and surgery.

Answer 2

Stress urinary incontinence

Question 3

occurs with a sudden sense of urgency (such as on the way to the bathroom or when washing hands) and can be treated with bladder training, medications, lifestyle changes, and neuromodulation.

Answer 3

Urgency urinary incontinence

Question 4

most commonly performed surgical procedures for stress urinary incontinence.

Answer 4

Minimally invasive synthetic midurethral slings

Question 5

a bag of smooth muscle that stores urine

Answer 5

THE BLADDER

Question 6

contracts to expel urine under voluntary control

Answer 6

THE BLADDER

Question 7

a low-pressure system that expands to accommodate increasing volumes of urine without an appreciable rise in pressure

Answer 7

THE BLADDER

Question 8

appears to be mediated primarily by the sympathetic nervous system

Answer 8

THE BLADDER

Question 9

when the bladder has filled to a certain volume, fullness is registered by tension-stretch receptors, which signal the brain to initiate

Answer 9

micturition reflex

Question 10

controlled by cortical control mechanisms, depending on the social circumstances and the state of the patient’s nervous system

Answer 10

MICTURITION REFLEX

Question 11

accomplished by voluntary relaxation of the pelvic floor and urethra, accompanied by sustained contraction of the detrusor muscle, leading to complete bladder emptying.

Answer 11

NORMAL VOIDING

Question 12

i. sympathetic

ii. parasympathetic divisions of the autonomic nervous system

iii. neurons of the somatic nervous system (external urethral sphincter)

Question: controls bladder emptying

Answer 12

parasympathetic divisions of the autonomic nervous system

Question 13

i. sympathetic

ii. parasympathetic divisions of the autonomic nervous system

iii. neurons of the somatic nervous system (external urethral sphincter)

Question: primarily controls bladder storage

Answer 13

sympathetic

Question 14

i. sympathetic

ii. parasympathetic divisions of the autonomic nervous system

iii. neurons of the somatic nervous system (external urethral sphincter)

Question: plays only a peripheral role in neurologic control of the lower urinary tract through its innervation of the pelvic floor and external urethral sphincter

Answer 14

neurons of the somatic nervous system (external urethral sphincter)

Question 15

The sympathetic nervous system originates in the

Answer 15

thoracolumbar spinal cord, principally T11 through L2 or L3

Question 16

postganglionic neurotransmitter is

Answer 16

norepinephrine

Question 17

What type of receptor is located principally in the urethra and bladder neck

Answer 17

α-receptors

Question 18

What type of receptor is located principally in the bladder body?

Answer 18

Beta-receptor

Question 19

controls bladder motor function—bladder contraction and bladder emptying

Answer 19

parasympathetic nervous system

Question 20

parasympathetic nervous system originates in the

Answer 20

sacral spinal cord, primarily in S2 to S4, as the somatic innervation of the pelvic floor, urethra, and external anal sphincter

Question 21

the main neurotransmitter used in bladder muscle contraction

Answer 21

acetylcholine

Question 22

• the most important facilitative center above the spinal cord
• serves as the final common pathway for all bladder motor neurons

Answer 22

pontine-mesencephalic gray matter of the brainstem
(aka pontine micturition center)

Question 23

serves as a major center for coordinating pelvic floor relaxation and the rate, force, and range of detrusor contractions

Answer 23

cerebellum

Question 24

Lower urinary tract disorders:
• disorders of storage

Answer 24

urinary incontinence

Question 25

Lower urinary tract disorders: emptying

Answer 25

urinary hesitancy and retention

Question 26

Lower urinary tract disorders: sensation

Answer 26

urgency or pain

Question 27

Any involuntary leakage of urine

Answer 27

Incontinence

Question 28

Involuntary leakage on effort or exertion, or on sneezing or coughing

Answer 28

Stress urinary incontinence

Question 29

Observation of involuntary leakage from the urethra, synchronous with exertion/effort, or sneezing or coughing

Answer 29

Stress urinary incontinence

Question 30

Involuntary leakage on effort or exertion, or on sneezing or coughing

Answer 30

Stress urinary incontinence

Question 31

Involuntary loss of urine associated with urgency

Answer 31

Urgency urinary incontinence

Question 32

Involuntary loss of urine associated with urgency and also with effort or physical exertion or on sneezing or coughing

Answer 32

Mixed incontinence

Question 33

Continuous involuntary loss of urine

Answer 33

Continuous urinary incontinence

Question 34

Number of voids per day, from waking in the morning until falling asleep at night

Answer 34

Frequency

Question 35

Micturition occurs more frequently during waking hours than previously deemed normal by women (traditionally defined as more than seven episodes)

Answer 35

Increased daytime urinary frequency

Question 36

Interruption of sleep one or more times because of the need to micturate (each void is preceded and followed by sleep)

Answer 36

Nocturia

Question 37

Involuntary loss of urine that occurs during sleep

Answer 37

Nocturnal enuresis

Question 38

Sudden, compelling desire to pass urine, which is difficult to defer

Answer 38

Urgency

Question 39

Involuntary loss of urine associated with change of body position, for example, rising from a seated or lying position

Answer 39

Postural urinary incontinence

Question 40

Urinary incontinence where the women has been unaware of how it occurred

Answer 40

Insensible urinary incontinence

Question 41

Involuntary loss of urine with coitus. This symptom might be further divided into that occurring with penetration or intromission and that occurring at organism.

Answer 41

Coital incontinence

Question 42

Urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology

Answer 42

Overactive bladder syndrome (OAB)

Question 43

estimates of urinary incontinence among community-dwelling women range from __

Answer 43

2% to 58%

Question 44

peak at 5th decade of life and the most common subtype

Answer 44

stress incontinence

Question 45

the most dominant subtype in late adulthood

Answer 45

mixed urinary incontinence

Question 46

Urinary incontinence Remission rates - equally high and range between

Answer 46

3% and 12%

Question 47

proposed that the primary support of the bladder neck and urethra to be an intact vaginal wall at the base of the bladder

Answer 47

Hammock Theory

Question 48

hypothesized that stress urinary incontinence occurs as a result of connective tissue laxity in the vagina and its supporting ligaments

Answer 48

Integral Theory

Question 49

a syndrome associated with urgency, usually accompanied by frequency, nocturia with (OAB-wet) or without (OAB-dry) urgency urinary incontinence, and in the absence of a urinary tract infection or other obvious pathology

Answer 49

overactive bladder (OAB).

Question 50

proposes presence of chemosensitizing agents leading to bladder instability which are believed to be inflammatory substances such as nerve growth factor, prostaglandins, and acetylcholine that increase detrusor muscle sensitivity and neuronal excitability

Answer 50

epithelial hypersensitivity theory

Question 51

suggests that the pelvic floor sustains a physical strain during the developmental years

Answer 51

myogenic theory

Question 52

the most common incontinence subtype in later adulthood

Answer 52

Mixed Urinary Incontinence

Question 53

occur mostly in the distal urethra of women between the ages of 30 and 60 years

Answer 53

urethral diverticuli -

Question 54

ectopic ureter is a congenital anomaly where the ureter opens distally into the urethra or more commonly into the vagina

Answer 54

ectopic urethra

Question 55

an acquired condition where there are one or more direct communications between the vagina and the following adjacent organs: a. ureter (ureterovaginal fistula) b. bladder (vesicovaginal fistula), c. urethra (urethrovaginal fistula)

Answer 55

fistula (traumatic)

Question 56

Most common fistula

Answer 56

bladder (vesicovaginal fistula)

Question 57

__ women are at a higher risk of developing stress urinary incontinence, whereas __ women are at a higher risk of developing urgency urinary incontinence

Answer 57

white women are at a higher risk of developing stress urinary incontinence, whereas black women are at a higher risk of developing urgency urinary incontinence

Question 58

Risk Factors of Urinary Incontinence

Question 59

major risk factor for urinary incontinence and its subtypes

Answer 59

Obesity

Question 60

independent risk factor for urgency urinary incontinence

Answer 60

Diabetes

Question 61

Reversible Causes of Urinary Incontinence

Answer 61

D I A P P E R S

Question 62

Diagnosis: 7-day bladder diary has been replaced with a

Answer 62

2- to 3-day diary

Question 63

Medications that May Affect the Function of the Urinary Tract

Answer 63

Slide 38

Question 64

intrinsic sphincter deficiency, also known as __

Answer 64

stove-pipe urethra

Question 65

the amount of urine remaining in the bladder within 10 minutes from voiding

Answer 65

Postvoid residual (PVR) volume of urine • Normal values - PVR <50 mL to be within normal • PVR >150 mL to be abnormally elevated

Question 66

can be administered before (bladder diary), during (urinalysis), or after (pad test) a clinical encounter - to assist the clinician in making a firm diagnosis

Answer 66

Simple Bladder Testing

Question 67

The hallmark of advanced bladder testing

Answer 67

urodynamics test

Question 68

Advanced Bladder Testing 􏰀 Urodynamics

Answer 68

Ppt 51

Question 69

a study that assess voiding function

Answer 69

Uroflowmetry

Question 70

several sensory parameters that are measured during the filling phase (with their typical normal values):

Answer 70

• first filling sensation (50 mL • first desire to void (150 mL) • strong desire to void (250 mL) • maximum cystometric capacity (400 mL)

Question 71

performed to assess bladder and urethral function during the filling phase

Answer 71

Filling Cystometry (Complex)

Question 72

the intravesical pressure (Pves) is a measure of the detrusor pressure (Pdet) plus the pressure of the abdomen and surrounding organs (Pabd) • True detrusor pressure is obtained by subtracting the value of the abdominal pressure from the intravesical pressure:

Answer 72

Pdet = Pves - Pabd

Question 73

test of urethral integrity which represents the value of the intra-abdominal or intravesical pressure at which point urine loss occurs

Answer 73

Valsalva leak point pressure (VLPP)

Question 74

Approximate Normal Values of Female Bladder Function

Answer 74

Ppt 70

Question 75

nonsurgical method to restore anatomy and function of genital relaxation

Answer 75

pelvic floor exercises were described by Arnold Kegel

Question 76

during a PFMT program - women are encouraged to

Answer 76

contract their pelvic floor muscles for 3 seconds, 10 to 15 times per session, and 3 times a day

Question 77

Medications in women who have a coexisting stress and urgency urinary incontinence

Answer 77

Imipramine

Question 78

an FDA-approved serotonin and norepinephrine reuptake inhibitor drug to treat depression, chronic pain, and anxiety, but not for stress urinary incontinence.

Answer 78

Duloxetine

Question 79

first-line treatment for urgency urinary incontinence, followed by medical interventions

Answer 79

Behavioral therapies

Question 80

second class of medications to treat urgency urinary incontinence

Answer 80

Beta agonists Mirabegron, which is a specific beta-3 receptor agonist

Question 81

a medication used to treat nocturia or enuresis = effective mostly through its central inhibitory action on reducing urine production

Answer 81

Desmopressin

Question 82

work centrally to improve sleep, and peripherally on the bladder and urethra to improve bladder storage

Answer 82

Imipramine

Question 83

can be helpful, especially in the presence of vascular insufficiency and peripheral edema

Answer 83

Furosemide

Question 84

Pharmacologic Therapies Indicated for Overactive Bladder with or without Urgency Incontinence

Answer 84

Ppt 97

Question 85

most commonly performed retropubic urethropexies

Answer 85

Marshall–Marchetti–Krantz (MMK) and Burch procedures

Question 86

__ was the original mid-urethral sling described by Ulmsten in 1996 - a simple minimally invasive outpatient procedure under local or regional anesthesia

Answer 86

Polypropylene tension-free vaginal tape (TVT)

Question 87

commonly performed vaginally, but can be repaired through an abdominal access, either open, laparoscopic, or robotically

Answer 87

Genitourinary fistula repair

Question 88

The mechanism of normal bladder emptying is a coordinated effort that is initiated by the individual

Answer 88

VOIDING DYSFUNCTION

Question 89

a uroflow when the voiding time is prolonged, the flow pattern is interrupted or the maximum flow rate is diminished

Answer 89

VOIDING DYSFUNCTION

Question 90

Desire to void during bladder filling occurs earlier or is more persistent from that previous experienced

Answer 90

Increased bladder sensation

Question 91

Definite desire to void occurs later than that previously experienced, despite an awareness that the bladder is filling

Answer 91

Reduced bladder sensation

Question 92

Absence of the sensation of bladder filling and a definite desire to void

Answer 92

Absent bladder sensation

Question 93

Delay in initiating micturition

Answer 93

Hesitancy

Question 94

Need to make an intensive effort (by abdominal straining, Valsalva or suprapubic pressure) to initiate, maintain, or improve urinary stream

Answer 94

Straining to void

Question 95

Urinary stream perceived as slower compared to previous performance or in comparison with others

Answer 95

Slow stream

Question 96

Urine flow that stops and starts on one or more occasions during voiding

Answer 96

Intermittency

Question 97

Bladder does not feel empty after micturition

Answer 97

Feeling of incomplete bladder emptying

Question 98

Involuntary passage of urine following the completion of micturition

Answer 98

Postmicturition leakage

Question 99

Urine passage is a spray or split rather than a single discrete stream

Answer 99

Spraying of urinary stream

Question 100

Requiring specific positions to be able to micturate spontaneously or to improve bladder emptying, for example, leaning forward or backward on the toilet seat or voiding in a semi-standing position

Answer 100

Position-dependent micturition

Question 101

Inability to pass urine despite persistent effort

Answer 101

Urinary retention

Question 102

a sudden and often painful inability to void despite the sensation of a full bladder and desire to urinate

Answer 102

Acute urinary retention

Question 103

PVR of more than 300 mL persisting for more than 6 months which has been documented in two separate occasions

Answer 103

Chronic urinary retention

Question 104

PVR of more than 300 mL persisting for more than 6 months which has been documented in two separate occasions

Answer 104

Chronic urinary retention

Question 105

treatment initiation for chronic urinary retention in high-risk patients

Answer 105

intermittent catheterization

Question 106

the complaint of suprapubic or retropubic pain, pressure, or discomfort related to the bladder

Answer 106

BLADDER PAIN SYNDROME

Question 107

associated with a defective glycosaminoglycan sulfate layer that covers the bladder mucosa

Answer 107

Interstitial cystitis

Question 108

a mixture of methenamine, methylene blue, phenyl salicylate, benzoic acid, and hyoscyamine

Answer 108

Prosed DS