urinary incontinence - anne

Question 1

what are the presentations of urinary incontinence

Answer 1

near constant dribbling or intermittent voiding
extreme urgency
occurs/worsens with intra-abdominal pressure
postvoid dribbling
family reports smell of urine
pt engages in “bathroom mapping”

Question 2

what is urge incontinence

Answer 2

most common type in older people
uncontrolled urine leakage after urgent need to void
nocturia/nocturnal incontinence common
precipitated by use of diuretic
exacerbated by inability to quickly reach bathroom
atrophic vaginitis in women

Question 3

what is stress incontinence

Answer 3

2nd most common in women
urine leakage due to increase intra-abdmonial pressure
leakage volume low to moderate
men: post surgical
more severe in obese pts

Question 4

what is overflow incontinence

Answer 4

2nd most common type of incontinence in men
dribbling of urine from overly full bladder
volume usually small, but leaks may be constant

Question 5

what is functional incontinence

Answer 5

urine loss due to cognitive or physical impairments or environmental barriers that interfere with control of voiding

Question 6

what is mixed incontinence

Answer 6

any combination of other types of incontinence

Question 7

what is the pathophysiology of urinary incontinence in post menopausal women

Answer 7

decreased estrogen leads to atrophic urethritis/vaginitis, decreased urethral resistance and closure pressure

Question 8

what is the pathophysiology of urinary incontinence in men

Answer 8

prostate size increases, partially obstructing urethra leading to incomplete bladder emptying and strain on detrusor muscle; facilitate incontinence but do not cause it

Question 9

what is the pathophysiology of urinary incontinence in younger patients

Answer 9

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

once cause in younger patients but several in older adults

Question 10

What is transient incontinence

Answer 10

“diappers”
Delirium
Infection
Atrophic urethritis and vaginitis
pharmaceuticals
Psychiatric disorders
Excess urine output
Restricted mobility
Stool impaction

Question 11

What is established incontinence

Answer 11

caused by persistent problem affecting nerves or muscles

Question 12

what are the mechanisms of estbalished incontinence

Answer 12

bladder outlet incompetence or obstruction
detrusor overactivity or under-activity
detrusor-sphincter dyssynergia
combination

Question 13

What is outlet incompetence

Answer 13

common cause of stress incontinence
in women, weakness of pelvic floor from multiple vaginal deliveries, pelvic surgery, age-related changes, or combo

Question 14

what is outlet incompetence in men

Answer 14

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

Question 15

What is outlet obstruction

Answer 15

common cause in men
both sexes: fecal impaction
women: previous surgery for incontinence, prolapsed cystocele

Question 16

what can obstruction lead to

Answer 16

chronically over distended bladder - loses ability to contract - does not empty completely resulting in overflow

detrusor overactivity and urge incontinence; detrusor muscle loses ability to contract

Question 17

What is detrusor overactivity

Answer 17

common cause of urge incontinece in older and younger
idiopathic of dysfunction of frontal micturition inhibitory center or outlet obstruction
detrusor overactivity with impaired contractility

Question 18

what is overactive bladder

Answer 18

described urinary urgency (with or without incontinence) often accompanied by urinary frequency and nocturia

Question 19

what can cause detrusor underactivity

Answer 19

injury to spinal cord or nerve roots supplying bladder, periphaeral/autonomic neuropathies, other neurological disorders

Question 20

what are the casues of detrusor underactivity in men

Answer 20

detrusor replaced by fibrosis and connective tissue with chronic outlet obstruction

Question 21

what can cause detrusor under-activity in women

Answer 21

usually idiopathic

Question 22

what is detrusor-sphincter dyssynegria

Answer 22

loss of coordination between the bladder contraction and external urinary sphincter relaxation; outlet obstruction with resultant overflow incontinence

Question 23

what is dyssynegria

Answer 23

often due to spinal cord lesion that interrupts pathways to pontine micturation center
-causes severe trabeculation, diverticula, “christmas tree” deformation of bladder (cystogram)

Question 24

what causes “christmas tree” deformation of the bladder

Answer 24

Dyssynergia

Question 25

What needs to be excluded before treatment of urinary incontinence

Answer 25

urinary retention

Question 26

what history is needed for the workup of incontinence

Answer 26

duration and patterns of voiding bowel function drug use obstetric and pelvic surgical history

Question 27

what needs to be assessed with physical exam for incontinence

Answer 27

neurological pelvic rectal exams are focus

Question 28

what are tests used for urinary incontinence

Answer 28

urinalysis, urine culture serum BUN, creatinine post void residual volume ~urodynamic testing

Question 29

what tests are required for urinary incontinence workup

Answer 29

UA, UCX, BUN and serum creatinine

Question 30

what is normal post void residual volume

Answer 30

<50ml, <100mg is usually acceptable for >65yo

Question 31

what is a postvoid residual volume of >200ml suggestive of

Answer 31

detrusor underactivity or oulet obstruction

Question 32

how can postvoid residual volume be measured

Answer 32

Catheterization or US

Question 33

when is urodynamic testing indicated

Answer 33

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

Question 34

What is urodynamics

Answer 34

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

Question 35

what is cystometrogram

Answer 35

testing bladder function, pressure and volume

Question 36

what is electromyography

Answer 36

recording of electrical activity within muscle tissue

Question 37

what is urethral pressure profile

Answer 37

measuring the balance of pressure along urethra

Question 38

what your uroflowmetry

Answer 38

testing of volume of urine released from the body

Question 39

what is pressure flow study

Answer 39

measuring the bladder pressure required to urinate and generated flow rate

Question 40

what is peak urinary flow rate testing used for

Answer 40

flow meter used to confirm of exclude outlet obstruction in men

Question 41

what is cystometry/cystometrography(CMG)

Answer 41

pressure-volume curves and bladder sensation recorded while bladder is filled with sterile water; provocation testing used to stimulate bladder contractions

Question 42

what is electromyography of perineal muscles used for

Answer 42

assess sphincter innervation and function

Question 43

what is pressure-flow video studies

Answer 43

usually done with voiding cystourethrography; correlates bladder contraction, bladder neck competency and detrusor-sphincter synergy; not widely available

Question 44

what are general treatment of urge incontinence urinary incontinence

Answer 44

limit fluid intake at certain times avoid fluids that irritate bladder (caffeine) drink 48-64 oz of fluid a day assistance for restricted mobility or cognitive impairments

Question 45

what are bladder training treatments for urge incontinence urinary incontinence

Answer 45

times voiding (every 2-3 hours) while awake prompted voiding for cognitively impaired voiding diary helps establish how often and when voiding is indicated

Question 46

what are the most common drugs used for urge incontinence urinary incontinence

Answer 46

oxybutynin and tolterodine

Question 47

when is immediate-release oxybutynin used

Answer 47

prophylactic if incontinence occurs at predictable times

Question 48

what is sacral nerve stimulation used for urinary incontience

Answer 48

sever urge incontinence refractory to other treatments it is a implanted neurostimulator

Question 49

what is posterior tibial nerve stimulation (PTNS)

Answer 49

application of low-voltage stimulation in 30 minute sessions Q weekly for 10-12 weeks

Question 50

when is surgery indicated for urge incontinence urinary incontinence

Answer 50

last resort usually younger patients with severe urge incontinence refractory to other treatments

Question 51

what is the most common surgical procedure for urge incontinence urinary incontinence

Answer 51

augmentation cystoplasty

Question 52

what is the treatment for stress incontinence

Answer 52

behavioral -bladder training, kegel exercises, avoid physical stress that provoke incontinence, losing weight, exercise using vaginal cones

Question 53

what are drugs that are used for stress incontinence

Answer 53

psudophedrine: women with outlet incompetence imipramine, duloxetine: mixed stress and urge incontinence or stres alone

Question 54

what is the treatment for stress incontinence if use to atrophic urethritis

Answer 54

topical estrogen

Question 55

what are surgery and devices used to treat stress incontinence urinary incontinence

Answer 55

non-invasive treatments ineffective occlusive devices

Question 56

what are treatment options for outlet obstruction

Answer 56

BPH or CA: drugs or surgery urethral structure: dilation or stenting cystoceles: surgery or reduced with pessary alternatives: electrical stimulation, cholinergic agonist bethanechol

Question 57

what are treatment options for overflow incontinence-detrusor under activity

Answer 57

bladder decompression or self cath, double voiding, valsalva maneuver, application of suprapubic pressure complete acontractile detrusor: requires intermittent self-cath or use of indwelling catheter

Question 58

what are the four types of urinary incontinence

Answer 58

urge, stress, overflow, functional