Flashcards in Urinary Incontinence Deck (8)
Patient with genuine stress incontinence: physical exam findings? Best initial treatment?
1. Hypermobile urethra
3. Loss of ureterovesicular angle
Kegel exercises and timed voiding
Each of the following is due to?
1. Genuine stress incontinence?
2. Urge incontinence?
3. Overflow incontinence?
1. Due to sudden increases in intra-abdominal pressure (in the absence of bladder muscle spasm)
2. Uninhibited and sudden bladder detrusor muscle contraction
3. Over distended, hypotonic bladder with absence of detrusor contractions
Investigation of pressure and volume changes in the bladder with filling of unknown volumes
Midurethral sling procedure?
Supporting midurethra with tensionless transvaginal tape or transobturator tape
Transvaginal tape procedure used to fix? Type of technique?
Transibturator tape procedure?
Proximal urethra retropubic; blind technique to place synthetic tape under urethra
Originating laterally to avoid bladder/bowel injuries due to transvaginal tape procedure
Normal effect of Valsalva on bladder/urethra?
Bladder and proximal urethra are normally intra-abdominal, so Valsalva increases pressure to BOTH the bladder and proximal urethra maintaining continence
Pathophysiology genuine stress incontinence?
1.Trauma/Weakness of the pelvic diaphragm (childbearing)
2. Proximal urethra falls below the pelvic diaphragm
3. Increasing abdominal pressure (Valsalva/cough) now exerted on the bladder but not proximal urethra
4. Incontinence without urge to void