Urology: Incontinence Flashcards Preview

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Flashcards in Urology: Incontinence Deck (147)
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1

What is frequency?

The need to void very often, typically affecting QOL (>8x / day)

2

What is nocturia?

Need to void during night, typically affecting QOL (>2x)

3

What is urgency?

Sensation to void that is so strong that fear of urine loss is imminent

4

What is incontinence?

Involuntary loss of any amount of urine

5

What is the prevalence of UI in community-dwelling older adults?

15%-30%

6

What is prevalence of UI in residents of long-term-care institutions?

60-70%

7

Does prevalence of UI increase with age?

Yes

8

Does UI affect more women or men?

-More women than men (2:1) until 80, then it's 1:1

9

How many people with UI seek medical attention?

Fewer than half

10

What are 2 categories of impact of UI on older adults?

1. Morbitidy
2. Cost: Over 26 billion annually

11

What are the morbidities associated with UI?

-Cellulitis, pressure ulcers, UTIs
-Sleep deprivation, falls with fractures (fall while going to bathroom at night), sexual dysfunction
-Depression, social withdrawal, impaired quality of life

12

What is required for continence?

-Mobility
-Manual Dexterity: To undress, use cane, ect.
-Cognitive Ability
-Motivation: Psychiatric spectrum
-Health
-Control of bladder contraction & urethral closure mechanisms

13

In normal micturiction, what is the bladder under control of?

The detrusor muscle

14

What does the detrusor muscle contract via?

PS nerves (S2-S4)

15

What does the proximal urethral smooth muscle contract via?

Sympathetic stimulation: T11-L2

16

What does the distal urethral striated muscle contract via?

Cholinergic somatic stimulation: S2-S4

17

In women, what does musculofascia do?

Supports and compresses the urethra when abdominal pressure increases

18

What is urine storage under control of and how does this function?

Sympathetic control:
-Inhibits detrusor contraction
-Increases sphincter contraction

19

What is voiding under control of and how does this function?

Paraympathetic control:
-Induces detrusor contraction
-Induces sphincter relaxation

20

As the bladder fills, what does sympathetic nerve activity do?

Increases the outlet resistance and inhibits detrusor contraction

21

When does somatic nerve activity increase?

As the bladder fills to tighten the pelvic floor

22

What changes occur with the aging process which can contribute to urinary incontinence?

-Decreased mobility
-Inability to postpone voiding
-Prostate hypertrophy
-Urethral dysfunction
-Increased night time urine volume

23

What are some age related lower urinary tract changes?

-Detrusor overactivity
-Benign prostatic hypertrophy
-Urine output shifted later in the day
-Atrophic vaginitis and urethritis
-(Modest) increase postvoid residual (PVR)
-Decreased ability to postpone voiding
-Decreased total bladder capacity
-Decreased detrusor contractility

24

What are 3 categories of factors contributing to or causing UI in older persons?

1. Comorbid disease
2. Neurological/Psychiatric
3. Function and environment

25

What are some examples of comorbid disease that can contribute to or cause UI in older persons?

- Diabetes: Peripheral neuopathy
- Congestive heart failure: Increased noctural peeing due to edema
- Degenerative joint disease
- Sleep apnea
- Severe constipation: Mega-colon...functional bladder capacity is decreased

26

What are some examples of neurological/psychiatric conditions that can contribute to UI in older persons?

-Stroke
-Parkinson’s disease
-Normal pressure hydrocephalus
-Dementias
-Depression: Lack of motivation

27

WHat are some examples of function and environment that can contribute to or cause UI in older persons?

-Impaired cognition: Recognize the need to urinate and what to do
-Impaired mobility
-Inaccessible toilets
-Lack of caregivers: Maybe need nighttime assistance?

28

What are come medications that can cause or worsen UI?

-Alcohol
-α-Adrenergic agonists
-α-Adrenergic blockers
-ACE inhibitors
-Anticholinergics
-Antipsychotics
-Calcium-channel blockers: Peripheral edema goes intravascularly
-Cholinesterase inhibitors
-Estrogen
-GABAergic agents
-Loop diuretics: Increased urine output
-Narcotic analgesics
-NSAIDs
-Sedative hypnotics
-Thiazolidinediones
-Tricyclic antidepressants

29

What are 3 categories of causes of nocturia?

1. Noctural polyuria (normal output >35% of total 24 hour output- 1/3 of normal daily output is at night)
2. Sleep Disturbance
3. Lower urinary tract

30

What are some causes of nocturnal polyuria?

-Late day/evening fluids, especially with caffeine or alcohol
-Pedal edema (i.e. due to medications, venous stasis, heart failure)
-Heart failure
-Obstructive sleep apnea : Interruption to sleep