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20 Cards in this Set
- Front
- Back
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3 key features that demonstrate a hyperactive bladder
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instability, hyperreflexia, low compliance
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Typical symptoms of bladder instability (4 key)
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frequency, nocturia, urgency, urge incontinence; may be asymptomatic
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What is the difference between motor and sensory urge urinary incontinence?
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Both have urgency/urge incontinence but with motor type unstable detrussor contractions are demonstrated on urodynamics. Those with sensory urge incontinence are likely able to inhibit these contractions during focused study but not during everyday activities.
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Description of pressure/volume curve in low compliance bladder
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steep
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2 most common causes of disrupted sensory pathyways of the detrussor
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Diabetes, pernicious anemia
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Give 4 classic causes of low bladder compliance
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prolonged foley, urinary diversion (defunctionalized bladder), neurogenic bladder (especially distal to conus), collagen deposition after radiation
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Give 3 classic causes of high bladder compliance
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Prolonged and progressive delayed voiding; peripheral neuropathies involving detrussor; spinal shock (usually first 6-8 weeks).
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Detrusor leak point pressure is helpful in the evaluation of what type of patient?
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One with low bladder compliance
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General relationship between detrussor leak point pressure (LPP) and upper tract dysfunction
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LPP above 40cm of water is highly associated with upper tract dysfunction regardless of continence
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Major factors that affect cystometrogram results that should be watched for
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incompetent outlet, massive reflux, rapid fill, lack of patient cooperation, substances/states irritative to the bladder.
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Use of the bethanechol supersensitivity test
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identify neurogenic cause of an acontractile bladder (denervation causes upregulation of receptors)
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What does a positive bethanechol supersensitvity test indicate?
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interuption in the afferent or efferent peripheral or distal spinal innervation of the bladder
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Causes for false negative test in bethanechol supersensitivity test
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obesity (inadequate dose)
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Causes for false positive test in bethanechol supersensitivity test
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detrusor hypertrophy, urinary tract infection, azotemia.
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What does the ice water test attempt to differentiate?
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upper motor from lower motor neuron lesions
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Describe a positive ice water test
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Water at zero degrees is instilled into the bladder. Test is positive if water expelled within one minute. Positive test is more suggestive of UPPER motor neuron lesions
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How often is the ice water test positive in lower motor neuron lesions?
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almost never
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Describe a false negative ice water test
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water not expelled despite measurement of contraction that appears close to typical micturition
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Factors that influence uroflowmetry
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effectiveness of detrusor contraction, completeness of sphincter relaxation, patency of urethra
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Are urolowmetry data age and gender dependent?
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yes
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