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Flashcards in Voiding dysfunction Deck (21):
1

conditions associated with OAB

Lack of estrogen (menopause)

obesity

pelvic organ prolapse

pelvic floor dysfunction

2

overflow incontinence

underactive detrusor with chronic retention and bladder overdistention

3

anatomic urethral obstructions

 

functional urethral obstructions

anatomic - prostatic enlargement

urethral stricture

poor incontinence surgery

functional (hyperactive sphincter)

neurogenic - detrusor sphincter dyssynergia

non-neurogenic - dysfunctional voiding

3

urinary incontinence due to sphincter = 

stress urinary incontinence

4

guarding reflex

micturirtion reflex can be abolished by external sphincter contraction

5

OAB  = ___ and leads to ____

OAB = detrusror overactivity leading to urge incontinence

5

causes of urinary retention due to detrusor

Neurogenic

myogenic

psychogenic

Rx - anticholinergics, a-agonists, narcotics

7

innvervation type

detrusor contractipon

internal sphincter relazation

detrusor contraction - parasympathetic

internal relaxation - sympathetic

8

CNS role 

volluntary control

inhibition of reflex detrusor contraction

9

coordinates voiding - detrusor contraction, internal, external sphincter relaxation

pontine mucturition center

10

urinary incontinence due to detrusor  =

overactive bladder / urge urinary incontinence

11

incontinence due to weakness of sphincter and supporting structures of neck and bladder

Stress urinary incontinence

12

causes / risk factors for Stress urinary incontinence

vaginal / pelvic trauma (births, surgery, trauma, vaginal prolapse)

lack of estrogen (menopause)

neurologic

radiation therapy > scarring

obesity

13

presentation OAB

spasms

urinary frequency + urgency

nocturia

incontinence - don't reach toliet in time 

15

management of retention

cathetar drainage (indwelling or intermittent

treat UTI

discontinue meds (anticholinergics)

relieve obstruction (alpha blockers to reduce sphincter tone, prostate surgery)

neuromodulation (for non-obstructive retention)

16

treatment stress incontinence

Kegels

weight loss

Duloexitine - 5HT+NE reuptake inhibitor > increase output to external sphincter

17

pathophys of post-op retention

anesthetics (antichlinergics) inhibit detrusor

increased sympathetic tone / bladder neck contraction

18

OAB treatment

Behavior - fluid management, kegels

 

Rx - antichilinergics (oxybutynin, tolterodine)

b-3 andrenergic agonist (myrbetriq)

19

sympathetic role

facilitates urine storage

inhibition of detrusor (directic via B3 adrenergic)

(indirect via inhibition of parasymptathetic

 

contraction of internal sphincter / bladder neck (a adrenergic receptors)

20

parasymptathetic role

facilitates micturition

direct motor action of detrusor contraction (ach, muscarinic receptors)

indirect facilitation of  detrusor contraction via stretch receptors

21

cause of OAB

UTI / inflammation

Neurologic - spinal cord injury, stroke MS

Metabolic (diabetes)

Urethral obstruction