Urinary incontinence

Question 1

What is urinary incontinence

Answer 1

near constant dribbling / intermittent voiding with / without awareness of the need to void

extreme urgency w little to no warning

Question 2

What is the most common type of urinary incontinence in elderly

Answer 2

urge incontinence

Question 3

What are the different types of urinary incontinence

Answer 3

Urge incontinence
stress incontinence
overflow incontinence
functional incontinence
Mixed incontinence

Question 4

What is urge incontinence

Answer 4

Uncontrolled urine leakage immediately after urgent, irrepressible need to void

Question 5

What exacerbates urge incontinence

Answer 5

use of diuretics and the inability ti quickly reach a bathroom

Question 6

What is stress incontinence

Answer 6

urine leakage due to abrupt increases in intra-abdominal pressure (cough / jumping)

Question 7

What are the typical causes of stress incontinence

Answer 7

Childbirth, pelvic floor laxity, atrophic urethritis, radical prostatectomy

Question 8

What are the typical causes of stress incontinence

Question 9

Which patients will experience more severe symptoms with stress incontinence

Answer 9

obese patients because of the excess abdominal pressure

Question 10

What is overflow incontinence

Answer 10

dribbling of urine from an overly full bladder

Question 11

What is the 2nd most common type of incontinence in men

Answer 11

overflow incontinence

Question 12

What is functional incontinence

Answer 12

Urine loss due to cognitive or physical impairments or environmental factors that interfere with voiding control

Question 13

What is mixed incontinence

Answer 13

Any combination of types

Question 14

What is mixed incontinence

Answer 14

Any combination of types

Question 15

What causes bladder incompetence

Answer 15

with aging, bladder capacity decrease and the ability to inhibit urination declines, bladder contractility is impaired

post void residual volumes increase

Question 16

What is the cause of bladder incompetence in men

Answer 16

prostate size increases, partially obstructing urethra, leading to incomplete bladder emptying and strain on detrusor muscle

Question 17

What generally causes bladder incompetence in younger patients

Answer 17

often begins suddenly, may cause some leakage and usually resolves quickly with little to no treatment

Question 18

What are some causes of transient incontinence

Answer 18

delerium
infection (symptomatic UTI)
atrophic urethritis/vaginitis
pharmeceuticals
psych disorders
excess urine output
restricted mobility
stool impaction

Question 19

What is the reason for established incontinence

Answer 19

persistant problem affecting nerves or muscles

Question 20

What are the mechanisms that may cause urinary incontinence

Answer 20

bladder outlet obstruction
detrusor over/under activity
detrusor sphincter dyssynergia
combination

Question 21

What is outlet incompetence

Answer 21

common cause of stress incontinence

Question 22

What is the main cause of outlet incompetence in women

Answer 22

pelvic floor weakness from vaginal deliveries or pelvic floor surgery

Question 23

What is the main cause of outlet incompetence in men

Answer 23

common cause is damage to sphincter or to bladder neck and posterior urethra after radical prostatectomy

Question 24

Why does an obstruction cause urinary incontinence

Answer 24

it causes an over distended bladder and the loss of ability to contract which leaves the bladder with a high residual volume and then causing overfill

Question 25

What is the common cause of urge incontinence in older and younger patients

Answer 25

detrusor overactivity

Question 26

What is overactive bladder

Answer 26

Describes urinary urgency, often accompanied by urinary frequency and nocturia

Question 27

What is the cause of detrusor under activity in men

Answer 27

fibrosis and connective tissue replace the detrusor leading to chronic outlet obstruction

Question 28

What is detrusor-sphincter Dyssynergia

Answer 28

Loss of coordination between bladder contraction and external urinary sphincter relaxation

Question 29

What is the most common cause of detrusor sphincter dyssynergia

Answer 29

Due to spinal cord lesions that interrupts pathways to pontine micturition center *causes Christmas tree deformations of the bladder

Question 30

Who should be screened for incontinence

Answer 30

all adults

Question 31

What will atrophic vaginitis and urethritis look on exam

Answer 31

pale, thin vaginal mucosa with loss of rugae

Question 32

How will you test for uretheral hyper mobility

Answer 32

Cough with the posterior vaginal wall stabilized with a speculum

Question 33

How do you preform a urinary stress test

Answer 33

A patient with a full bladder, sit up on an exam table with their legs spread and relaxes the perineal are and coughs vigorously once

Question 34

What confirms an incontinence diagnosis

Answer 34

Immediate leakage that starts and stops with cough on the urinary stress test

Question 35

What does delayed or persistent leakage indicate with a urinary stress test

Answer 35

detrusor overactivity

Question 36

What is the Marshall-Bonney test

Answer 36

Repeat the urinary stress test, except with 1-2 fingers inside the vagina to elevate urethra

Question 37

What is the purpose of the Marshall-Bonney test

Answer 37

to see if the patient may respond to surgery

Question 38

What tests can be preformed when working up urinary incontinence

Answer 38

urinalysis / urine culture BUN/Creatinine postvoid residual volume urodynamic testing

Question 39

When is urodynamic testing done

Answer 39

when clinical eval and appropriate tests are not diagnostic or when abnormalities must be precisely characterized before surgery

Question 40

What is the purpose of measuring post void residual volume

Answer 40

PVR + voided volume estimates the total bladder capacity and assess bladder proprioception

Question 41

What is normal PVR

Answer 41

<50

Question 42

What is PVR suggests detrusor under activity or outlet obstruction

Answer 42

>200mL

Question 43

What is urodynamics

Answer 43

term for all encompassing series of tests and procedures regarding the lower urinary tract

Question 44

What is a cystometrogram

Answer 44

testing bladder function, pressure, and volume

Question 45

What is electromyography

Answer 45

recording of electrical activity within muscle tissue

Question 46

What is the urethral pressure profile

Answer 46

measuring the balance of pressure along the urethra

Question 47

What is uroflowmetry

Answer 47

Testing the volume of urine released from the body

Question 48

What are some general treatment measures for incontinence

Answer 48

Limit fluid intake at certain times avoid fluids that irritate bladder portable commode check drugs that could aggravate

Question 49

What are some ways to bladder train

Answer 49

Timed voiding *urinate every 2-3 hours while awake Prompted voiding *for cognitively impaired patients Using a voiding diary to track all voids

Question 50

Which for of incontinence are Kegel exercises most useful for

Answer 50

stress incontinence

Question 51

What are Kegel exercises

Answer 51

Contract the pelvic floor muscles rather than the thigh, abd, and buttock muscles. *contract 10 seconds, relax 10 seconds, 10-15xs TID

Question 52

What are automative Kegel exercises

Answer 52

pelvic floor electrical stimulation

Question 53

What is the purpose of relaxation techniques for urinary incontinence

Answer 53

improve emotional and physical responses to the urge to void

Question 54

What are the most common drugs to help with urge incontinence if not managed with behavioral therapy

Answer 54

Oxybutynin and tolterodine *anticholinergic and antimuscarinic

Question 55

what is onabotulinum and when is it used

Answer 55

administered via cystoscopic injection into detrusor muscle useful for surge incontinence refractory to other treatment in patients with neurologic causes

Question 56

What are some procedures for urge incontinence

Answer 56

Sacral nerve stimulation posterior tibial nerve stim surgery

Question 57

What is sacral nerve stimulation

Answer 57

implantedd neurostimulator

Question 58

What is posterior tibial nerve stimulation

Answer 58

Application of low voltage stimulation for 30 min sessions for 10-12 weeks

Question 59

How do you treat stress incontinence

Answer 59

bladder training kegel exercises avoiding stressors that provoke losing weight if obeses exercise with vaginal cones

Question 60

What are some drugs for stress incontinence

Answer 60

pseudoephedrine imipramine / duloxetine topic estrogen

Question 61

When is topical estrogen indicated

Answer 61

atrophic urethritis

Question 62

What is pseudoephedrine indicated

Answer 62

women with outlet incontinence

Question 63

When is imipramine and duloxetine indicated

Answer 63

mixed stress and urge incontinence or stress alone

Question 64

How can you treat overflow incontinence

Answer 64

bladder decompression with intermittent self catheterization