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31 Cards in this Set
- Front
- Back
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Prevalence of urinary incontinence
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50% of women at some time
20% of women over 75 - major reason to place in nursing home |
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types of U. incontinence
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stress
urge (detrusor instability) total (continuous leakage due to fistula) overflow |
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contains trigone at its base
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detrusor mm of the bladder
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junction of the bladder and urethra
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internal sphincter (UVJ)
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external sphincter formed by ?
HINT: say PUL ! the external sphincter. |
pubourethral ligament (lower pubic bone) to middle third of the urethra forms the external sphincter
http://www.integraltheory.org/anatomy/index.html#Structure |
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maintenance of continence (pressure gradient and it's maintenance)
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intraurethral pressure exceeds the intravesical pressure via continuous contraction of the internal sphincter
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provides 50% of urethral resistance and is second line defence against incotinence
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external sphincter
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urethral vascular complex filling with blood
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mucosal coaptation (estrogen sensitive)
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allows mic
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parasympathetic NS
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S2, S3, S4
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parasympathetic bladder control
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prevents mic by contracting the bladder neck and internal sphincter
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sympathetic NS
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sympathetic bladder control
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hypogastric nerve (T10-L2)
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innervates striated mm of the external sphincter and pelvic floor through the pudendal nerve providing voluntary control
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somatic NS
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relaxation of the urethra, external sphincter & levator ani mm (reflex arc)
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stretch receptors from bladder wall send signal to CNS which inhibits sympathetic sacral and pudendal nerves
sacral plexus: L4-S3 pudendal nerve: S2,3,4 |
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contraction after gentle tapping or squeezing of the clitoris
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bulbocavernosus reflex
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pt stands over towel & coughs
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standing stress test
- stress incontinence |
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hypermobile bladder neck dx:
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cotton swab range 30-60 degrees
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test for detrusor instability
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cystometrogram
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med txs in to strengthen pelvis in stress incontinence
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alpha adrenergic agents (phenylpropanolamine and pseudoephedrine), estrogen
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another name for urge incontinence
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detrusor instability
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involuntary and uninhibited detrusor contractions during the filling phase of bladder function
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detrusor instability (urge incontinence)
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involuntary urine loss even when bladder is not full
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detrusor instability
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what neurotransmitter causes bladder contraction ?
what's the medical tx ? |
parasympathetic NS stimulation by acetylcholine (Ach)
Pro-Banthine (oxybutynin) |
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Name all meds used in urge incontinence
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Pro-Banthine (oxybutynin)
Alupent (beta-adrenergic agonist) Urispas (sm mm relaxant) TCAs (imipramine) |
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fistula between bladder & vagina causes what ?
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total incontinence
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MC cause of genitourinary fistulas in the US
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pelvic radiation or pelvic surgery
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accounts for over 50% of vesicovaginal fistuals
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hysterectomy (abdominal or vaginal)
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vesicovaginal fistula test
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methylene blue leak from bladder into the vagina after instillation into the bladder
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indigo carmen IV
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ureterovaginal fistula dx
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reduces urethral closing pressure in overflow incontinence
striated mm relaxants chlinergic agent to increase bladder contractility |
prazosin, terazosin, phenoxybenzamine
diazepam, dantrolene bethanecol |
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postop & overdistension occurs less frequently in:
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women
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