UI 1 Flashcards
1
Q
What are the 6 types of Urinary Incontinence?
A
- Stress UI
- Urge UI
- Mixed
- Unaware (unconscious)
- Nocturnal enuresis
- Continuous
2
Q
What are the 5 underlying pathophysiologies of UI?
A
- Intrinsic sphincteric deficiency (ISD)
- Urethral hypermobility
- Detrusor overactivity
- Low bladder compliance
- Urinary retention
3
Q
Transient Causes of UI
A
DIAPPERS
- Delirium
- Infection
- Atrophic vaginitis
- Pharmaceuticals/Polypharmacy
- Psychological
- Excessive Urine Production
- Restricted Mobility
- Stool Impaction / Constipation
4
Q
2 exam findings on rectal exam for UI
A
- stool impaction
- bulbocavernosal reflex
5
Q
5 PE components for UI
A
- Female: pelvic
- Male: prostate
- Perineal sensation
- Rectal exam: stool impaction , bulbocavernosal reflex
- LE: edema
6
Q
3 components of PE for pelvic exam of female for eval of UI
A
- Vaginal epithelium: atrophic vaginitis
- Cotton swab test (place cotton swab in urethra, change of 30 degrees w/ strain = urethral hypermobility)
- Cough test (observe for leaking w/ cough)
7
Q
5 studies
A
- UA / culture (glucosuria, infection)
- Voiding diary (voids, incontinence, fluid consumption, BMs)
- Post-void residual: retention
- Cytoscopy: stricture, tumor
- Urodynamic study
8
Q
3 imaging studies for UI
A
- Voiding cystourethrogram
- Pelvic Imaging (MRI)
- Neurologic Directed Imaging
9
Q
What are the tx for UI caused by these?
- Delirium
- Infection
- Atrophic Vaginitis
- Pharmaceuticals
- Psychological
- Excessive UOP
- Restricted mobility
- Stool impaction/constipation
A
- Delirium –> tx underlying cause
- Infection–> abx
- Atrophic Vaginitis–> topical vaginal estrogens
- Pharmaceuticals–> elimination/adjustments
- Psychological–>psych referral
- Excessive UOP–>tx/manage cause, alter timing of fluid intake/diuretics, elevation of LE
- Restricted mobility–> bedside commode / urinal
- Stool impaction/constipation–> bowel management
10
Q
Tx of Urinary Retention?
(4)
A
-
tx to empty bladder
- avoid certain OTC meds (cough/cold meds)
- Catheterization
- BPH medication
- Surgery
11
Q
Test and Tx for Continuous Incontinence caused by vesicovaginal fistula
A
- Test: Pyridium test: place tampon in vagina, give Pyridium, if tampon is orange the pt has fistula.
- Tx: surgery
12
Q
3 Non-Invasive Tx for Female Stress Urinary Incontinence (SUI)?
A
- Behavioral Therapy
- Medication
- Continence Devices (pessary, catheter)
13
Q
Minimally Invasive Tx for Female SUI
A
Bulking Agents
14
Q
4 Surgical Tx for Female SUI
A
- Anterior Repairs
- Suspensions
- Artificial Urinary Sphincter
- Sling procedures
15
Q
4 tx options for Non-Invasive Behavioral Therapy for Female SUI
A
- Pelvic Floor Muscle Training (PFMT)
- Avoidance of constipation
- Elevation of edematous lower extremities (helpful for night time incontinence)
- Timed voiding to prevent leakage
16
Q
A
17
Q
2 components of bladder training for female SUI
A
- Gradually increase time between voids
- Suppress urge w/ breathing exercises, mental imagery, distraction, or pelvic floor muscle contractions
18
Q
Tx for what?
- Fluid intake modification: drink fluids earlier in day, avoid right before bed time
- Dietary modification: avoid bladder irritants (caffeine, ETOH, spicy foods, acidic foods)
- Weight loss (decrease in abd pressure / pressure on bladder)
A
Tx for Female SUI
19
Q
Tx for Female SUI (non-invasive)
- Avoidance of ____
- Elevation of edematous LE during what time of day?
- Compression stockings
- Void before ____
A
- constipation
- PM prior to hs to mobilize fluid
- going to sleep to avoid nocturia
20
Q
Tx for Female SUI : Pelvic Floor Muscle Training (PFMT)
- Indicated for which 3 types of UI?
- Maximal isometric contractions of pelvic floor muscles
- Contract for __ to __ seconds, relax
- __ repetitions
- __ sets / day
- Teaching by professional
A
- SUI, UUI, Mixed UI
- 6-8
- 10 reps
- 3 sets
21
Q
Which medication for tx of femle SUI?
- increases muscle tone of urinary sphincter
- Not FDA approved for this indication
- Pseudoephedrine, ephedrine, imipramine
A
Alpha Agonists
22
Q
7 Contraindications of Alpha Agonists (Pseudoephedrine, ephedrine, imipramine)
A
- cardiac disease
- uncontrolled HTN
- narrow angle glaucoma
- hyper-thyroidism
- DM
- MAOI use (monoamine oxidase inhibitors)
- at risk for seizures
23
Q
Which medication for tx of Female SUI?
- Serotonin & NE reuptake inhibitor
- Nausea
- Higher than expected rate of suicide
- Not FDA approved for this indication
A
Duloxetine
24
Q
What are the 3 “continence devices” for tx of female SUI?
A
- Pessary (taco time) - changed monthly
- Indwelling urinary catheter (urethral or suprapubic)
- Urethral occlusive device
25
**Tx for Female SUI : Bulking Agents**
* Injection of material adjacent to the proximal \_\_\_/\_\_\_\_
* Coats the \_\_\_\_\_\_\_\_
* Increases bladder outlet resistance
* Generally done \_\_\_\_\_\_
* Single or multiple txs?
* urethra/bladder neck
* urethral mucosa
* transurethrally
* multiple
26
**Tx for Female SUI : Bulking Agents**
* 4 types of agents?
* Skin test to check for \_\_\_\_
* Can migrate to \_\_\_
* ____ visible on x-rays
* collagen, graphite, calcium hydroxyapatite, silicone
* allergic rxn
* lymphatic system
* calcium
27
4 types of surgeries for tx of Female SUI?
* Anterior repair
* Suspension
* Artificial Urinary Sphincter
* Sling
28
**Which surgery for Female SUI?**
* _____ fascia imbricated ____ to support the bladder
* pubocervical / posteriorly
29
**Which surgery for Female SUI?**
* Marshall-Marchetti-Krantz (MMK) - periurethral
* Burch - perivesical
Suspension
30
In which patients would you use a "sling" surgery for tx of Female SUI?
pts w/ urethral hypermobility (\>30 degrees)
31
**Tx of Female SUI**
* like a "hammock" under urethra
* autologous fascia
* allograft
* xenograft (porcine, bovine)
* synthetic
Sling
32
**Surgery for Female SUI**
* If there is overcorrection, urinary retention may require intermittent _____ (temporarily)
* Possibility of sling erosion into the \_\_\_, \_\_\_, \_\_\_
* leading to sxs including....
* catheterization
* vagina, urethra/bladder
* dyspareunia, vag pain, vag discharge, vag bld
* dysuria, hematuria, urinary urgency, urinary freq, recurrent UTI, recurrent SUI
33
What tx of female SUI is considered "minimally invasive?"
Bulking Agents
