Renal. Incontinence + UW elderly incont (08-15) (1)

Question 1

UW incontinence.
STRESS. what symptoms?

Answer 1

leaking with Valsalva maneuver (caughing, sneezing, laughing)

this maneuver leads to increased intraabdominal pressure

Question 2

UW incontinence.
leaking with Valsalva maneuver (caughing, sneezing, laughing)?

Answer 2

stress

Question 3

UW incontinence.
STRESS. what treatment?4

Answer 3

lifestyle modifications

pelvic floor exercise

pessary and Kegel

pelvic floor surgery

FA: urethral sling procedure (WTF)

Question 4

UW incontinence.

lifestyle modifications
pelvic floor exercise
pessary
pelvic floor surgery

in what?

Answer 4

stress

Question 5

UW incontinence. URGENCY. Symptoms?

Answer 5

sudden, overwhelming, or frequent need to void

Question 6

UW incontinence.
sudden, overwhelming, or frequent need to void?

Answer 6

Urgency

Question 7

UW incontinence.
Urgency. Treatment? 3

Answer 7

Lifestyle modification
Bladder training
antimuscarinic drugs

Question 8

UW incontinence.

Lifestyle modification
Bladder training
antimuscarinic drugs

in what?

Answer 8

Urgency

Question 9

UW incontinence.
MIXED. symptoms?

Answer 9

Features of stress and urgency

Question 10

UW incontinence.
Features of stress and urgency?

Answer 10

Mixed

Question 11

UW incontinence. mixed treatment?

Answer 11

variable treatment depending on predominant symptoms

Question 12

UW incontinence.
variable treatment depending on predominant symptoms

in what?

Answer 12

MIXED

Question 13

UW incontinence.
OVERFLOW. symptoms?

Answer 13

Constant involuntary dribbling and incomplete emptying

Question 14

UW incontinence.

Constrant involuntary dribbling and incomplete emptying

Answer 14

Overflow

Question 15

UW incontinence.
OVERFLOW treatment? 3

Answer 15

Identification and correction of underlying cause

Cholinergic agonists

Intermitent self-catheterization

Question 16

UW incontinence.

Identification and correction of underlying cause

Cholinergic agonists

Intermitent self-catheterization

in what?

Answer 16

Overflow

Question 17

FA. incontinence. mechanism?

Answer 17

involuntary loss of urine cause by either bladder or urethral sphincter dysfunction.

Question 18

FA. incontinence. Mneumonic of causes?

Answer 18

DIAPPERS

Delirium/confusion
Athrophic urethritis/vaginitis
Pharmaceutical
Psychiatric disorders (esp. depression)
Excessive urinary output (hyperglycemia, hypercalcemia)
Restricted mobility
Stool impaction

Question 19

FA. incontinence.
Diagnosis. urine labs

Answer 19

Urinalysis - pyuria suggests UTI.
Creatinine - can reveal renal dysfunction if urinary obstruction leading to overflow is suspected.

Question 20

FA. incontinence.
Diagnosis. what patients have to do to follow volume?

Answer 20

Voiding diaries - helps to define type of incontinence

Question 21

FA. incontinence.
Diagnosis. instrumental testing?2

Answer 21

Urodynamic and radiographic testing - not routinely. used if considered surgery

Question 22

FA. incontinence. Stress mechanism?

Answer 22

Urethral sphincter insufficiency caused by laxity of pelvic floor musculature

Question 23

FA. incontinence. Stress in what patients? 2

Answer 23

multiparous women or after pelvic surgery

Question 24

FA. incontinence. Urgency. how it happens?

Answer 24

unexpected urge to void unrelated to position or activity

Question 25

FA. incontinence. Urgency. mechanism?

Answer 25

in bladder outlet obstruction (BPH or drugs that incr. sphrincter tone) or detrusor overactivity

Question 26

FA. incontinence. Urgency. pelvic floor exercise, bladder training what drugs? 1st and 2nd line

Answer 26

Anticholinergic - 1st line B agonists eg mirabegron - 2nd line

Question 27

FA. incontinence. Overflow. what situation?

Answer 27

dribbling after incomplete emptying of bladder

Question 28

FA. incontinence. Overflow. mechanim?

Answer 28

chronically distended bladder with intravesical pressure that just exceeds the outlet resistance --> small amount of urine to dribble out

Question 29

FA. incontinence. Overflow. treatment

Answer 29

urethral cath in acute setting treat underlying cause timed voiding/catheterization

Question 30

FA. incontinence. Total. what situation?

Answer 30

uncontrolled loss and at all times and all positions

Question 31

FA. incontinence. Total. mechanism? 2

Answer 31

loss of sphincter efficiency (previous surgery, nerve damage, cancer infiltration) Abnormal connection between urinary tract and skin (fistula)

Question 32

FA. incontinence. Total. treatment?

Answer 32

surgery

Question 33

UW. incontinence in elderly. genitourinary causes? 4

Answer 33

decr. detrusor musle contractility, detrusor overactivity Bladder/urethral obstruction (cancer, BPH) Urethral sphincter/pelvic floow weakeness Urogenital fistula

Question 34

UW. incontinence in elderly. Neurologic causes? 3

Answer 34

Multiple sclerosis Dementia (parkinson, alzheimer, NP hydrocephalus) Spinal cord injury/disc herniation

Question 35

UW. incontinence in elderly. Potentially reversible causes?

Answer 35

DIAPPERS Delirium Infection (UTI) Pharmaceutical (alfa blockers, diuretics) Psychological (depression) Excessive urine output (DM, CHF) Restricted mobility (post surgery) Stool impaction

Question 36

UW. incontinence in elderly. most common cause?

Answer 36

UTI Once excluded --> additional tests to rule out other causes

Question 37

UW. incontinence in elderly. 3 groups medications as cause

Answer 37

alpha blockers: relaxes urethra Diuretics: xxcessive urine production Anticholinergic, opiatres, CCB: urinary retention and overflow