Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
50 Cards in this Set
- Front
- Back
|
What's the definition of urinary incontinence?
|
Complaint of loss of urine without control
|
|
|
What's the definition of pelvic organ prolapse?
|
Loss of normal support of vaginal walls
|
|
|
What are some conditions that can cause prolapse/incontinence?
|
Pregnancy (HIGHEST RISK.)
Delivery Myopathy Neuropathy Surgery |
|
|
What are some risk factors for prolapse/incontinence?
|
Obesity
Smoking Pulmonary disease Constipation Extreme recreational/occupational activities |
|
|
What's the prevalence of incontence in women?
|
25-45%!
ASK YOUR PATIENTS. |
|
|
What are the different phases of normal voiding?
|
Filling
Voiding |
|
|
What is the effect of sympathetic firing on the bladder?
|
Contraction of the smooth and striated muscles of the sphincters
Inhibition of bladder contraction |
|
|
What nerves carry sympathetic information to the bladder?
|
Hypogastric nerve
Pudendal nerve |
|
|
What part of the brain monitors bladder storage?
|
Rostral pons
|
|
|
What happens as the bladder fills?
|
More and more afferent firing
|
|
|
What part of the nervous system causes bladder contraction?
|
Parasympathetic firing.
|
|
|
What types of receptors are responsible for normal voiding?
|
Cholinergic, muscarainic receptors in the detrusor smooth muscle
|
|
|
What types of receptors are in the urinary sphincter?
|
Alpha receptors
|
|
|
What are the changes that occur to the bladder as you age?
|
Decreased detrusor contractility (increased residual volume)
Urethral sphincter coaptation decreases Also, there's more urine volume at nightttime |
|
|
What is a cause of more urine volume at nighttime?
|
Decreased ADH
More renal bloodflow due to edema |
|
|
What's the presentation of UTI or pyelonephritis?
|
Acute onset
Burning with urination Running to the bathroom, small volumes Hematuria Fever, back pain Related to intercourse |
|
|
What are some conditions that you want to rule out with relation to incontinence?
|
UTI
Pyelonephritis Interstitial cystitis/painful bladder syndrome Bladder cancer |
|
|
What's the presentation of interstitial cystitis/painful bladder syndrome?
|
Frequent small-volume voiding
Younger Burning with filling "I never leak" |
|
|
What's the presentation of someone with bladder cancer?
|
Long-term smoker
No pain No stones Urinates often, with urgency |
|
|
What are the different kinds of urinary incontinence?
|
Urgency urinary incontinence
Stress urinary incontinence Mixed urinary incontinence Overflow incontinence Functional incontinence |
|
|
What are some complaints in incontinence?
|
Urgency
Spasms |
|
|
What's the definition of overflow incontinence?
|
Detrusor hyperactivity with impaired contractility: dribbling on the way to the toiled
|
|
|
What are the symptoms of overflow incontinence?
|
Weak urinary stream
Dribbling Intermittency Hesitancy Frequency Nocturia |
|
|
How do you check for overflow incontinence?
|
If there's a large post-residual volume, there's a good chance that someone has it.
|
|
|
What are some key points in a history of urgency urinary incontinence?
|
Onset
Time course PMH Leakage: triggers, pad use, number of leaks Diet Meds |
|
|
What are the tests that you can run for incontinence?
|
Cough stress test
Urine dip PVR testing Voiding diary Urodynamic testing |
|
|
What are some treatments for urinary urge incontinence?
|
Behavioral:
-Cut down on certaince substances: caffeine, nicotine, artifical sweetners -Timed voiding Pelvic floor muscle therapy: -Kegel exercises -PT |
|
|
What are some meds that we can use for urinary urge incontinence?
|
Anticholinergics (muscarinic receptor antagonists)
|
|
|
What is the effect of giving cholinergics?
|
INcrease bladder capacity
Decrease urgency |
|
|
What are the side effects of the anticholinergics?
|
Dry eye
Dry mouth Constipation Most people stop taking them because of the side effects. |
|
|
What don't you give to treat incontinence?
|
Estrogen!
It makes it worse. |
|
|
What are specialized drugs for the treatment of incontinence?
|
Beta-3 adrenoreceptor agonists
|
|
|
What is the effect of using the beta-3 receptor agonists?
|
Enhancing storage function and relaxing the urinary bladder
|
|
|
What's an injection that works well in iincontinence
|
Botox!
It works well - too well. Retention resulted. |
|
|
What are some other treatments of incontinence?
|
Interstim
Tibila nerve stimulation Augmentation cystoplasty |
|
|
What happens in augmentation cystoplasty?
|
Insertion of intestine into the bladder.
Not done. |
|
|
What's the definition of stress urinary incontinence?
|
Loss of urine involuntarily with effort/physical exertion
|
|
|
What's the cause of stress urinary incontinence?
|
Increase in abdominal pressure causes urine to leak out due to a failure in urethral integrity
|
|
|
What are the treatment options for stress urinary incontinence?
|
No meds!
Surgery Weight loss!!! Bulking injections |
|
|
What kinds of surgeries are done for stress incontinence?
|
Retropubic sling
Transobturator sling |
|
|
What are the different types of prolapse?
|
Cystocele
Rectocele Enterocele Uterine prolapse Vaginal vault prolapse |
|
|
What are the muscles that support the contents of the pelvus?
|
Levator ani muscles
|
|
|
What is cystoele?
|
Dropping of the bladder wall into the anterior wall of the vagina
|
|
|
What happens when the anterior the vaginal wall prolapses?
|
Cystocele
|
|
|
What happens when the posterior the vaginal wall prolapses?
|
Rectocele
|
|
|
What is an enterocele?
|
True hernia of the pelvus: small intestine is involved
|
|
|
Will surgery for a rectocele cure the problem of constipation?
|
NO.
There are other factors that cause the issues, not the rectocele |
|
|
What are the treatments for prolapses?
|
Pesaries: something that holds the bulge in.
Surgery!: |
|
|
What are the aims of prolapse surgery?
|
Restore normal anatomy!
SURGERY FTW!!!!!!!!!!! |
|
|
What shouldn't you give to patients for prolapse?
|
Mesh.
It's horrid: Infection Contraction Exposure Pain |
