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10 Cards in this Set
- Front
- Back
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What is the differential diagnosis of incontinence? (5)
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Total: incompetent sphincter, fistula
Stress: partially incompetent sphincter Urge: overactive bladder Overflow: atonic/hypotonic bladder) Mixed |
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Name the different neurological components that control the lower urinary tract and for each name: what they do, what injuries can occur to affect them and what happens if they are injured
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1. Cortical: volitional control of urge to pee, CVA, DH (neurogenic OA)
2. PMC/SC: coordination of bladder contraction and sphincter opening, spinal cord injury, bladder atony first followed by DH +/- DSD S2-4: sends signals to bladder (contract) and sphincter (relax) to cause voiding, pelvic surgery, atonic bladder |
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What is the functional classification for voiding dysfunction?
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1.Failure to store: bladder (overactive) or outlet (incompetent)
2. Failure to empty: bladder (hypoactive/hypotonic), or outlet (obstruction) |
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What happens with a lesion in the following locations: above brain stem, brainstem-T6, T6-S2, below S2
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1. Above brain stem: involuntary bladder contractions (overactive bladder), coordinated sphincter function
2. Brainstem-T6: Autonomic dysreflexia + smooth sphincter dyssynergy (incomplete emptying) 3. T6-S2: Striated muscle dyssynergia (incomplete emptying), loss of sensation (retention and decreased compliance) Below S2: No overactive bladder, detrusor areflexia +/- decreased compliance (atonic bladder), open smooth sphincter (totally incompetent), fixed resting striated sphincter tone (partially incompetent) |
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Case of surgically removed smooth sphincter (outlet incompetence): Differential, Work-up, Treatment
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1. Differential: overactive bladder, outlet incompetence, obstruction (sphincter/scar)
2. Work-up: History, Physical, tests (urinalysis, urine C&S, serum creatinine), U/S (for post void residual/r/o overflow incontinence), cystoscopy (for blockage and sphincter), video urodynamics (for bladder function r/o overactive bladder and stress incontinence) Treatment: Artificial urinary sphincter, male advance sling |
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Case of post-stroke (overactive bladder): Differential, Work-up, social impact, treatment
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1. Differential: bladder overactivity, outlet incompetence, obstruction (stricture/scar)
2. Work-up: History, Physical, Tests (urinalysis, urine C&S, serum creatinine), U/S (post-void residual), cystoscopy (urethral stricture, UTI, cancer), urodynamics (bladder function) Social impact: decreased quality of life, dependance, expensive Treatment: Facilitate Storage (timed bladder emptying, anticholinergics to relax bladder, CIC if not emptying, BOTOX), Increase Outlet Resistence (pelvic floor exercises/physiotherapy/biofeedback/electrical stimulation, alpha-adrenergic agonists, beta-adrenergic antagonists) |
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Case of stress incontinence: Differential, Pathophysiology, Work-up, Treatment
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1.Differential: overactive bladder, outlet incompetence, obstruction (cystocele, stricture/scar)
2. Pathophysiology: pelvic floor weakened which leads to bladder neck descent 3. Work-up: History, Physical, Tests (urinalysis, urine c&s), cystoscopy, video urodynamics (leak point pressure, r/o overactive bladder) 4. Treatment: behavioural (timed voiding, avoid diuretics, limit fluids), physioltherapy/biofeedback/kegel exercises, surgery (mid urethral tapes, bladder neck suspension, sub-mucosal bulking agents, pelvic floor reconstruction) |
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Case of C7 spinal cord injury (neurogenic bladder): Differential, Pathophysiology, Goals of Management, Treatment
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1. Differential: detrusor sphincter dyssynergy, autonomic dysreflexia
2. Pathophysiology: Lesion in SC leads to uncoordinated bladder contraction/sphincter relaxation (DSD), bladder distention + SC lesion above T6 causes autonomic dysreflexia 3. Goals of management: maintain normal renal function, prevent UTI's, achieve continence, social acceptability Treatment: facilitate urine storage by relaxing bladder muscle (anticholinergics, surgical bladder augmentation), maintain low bladder pressure, promote complete bladder emptying (CIC, decrease outlet resistance, urethral stents, BOTOX) |
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Case of female 1 wk post recto-sigmoid resection (mixed/overflow incontinence): Differential, Pathophysiology, Treatment
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1. Differential: Total (completely incompetent sphincter), Stress (partially incompetent sphincter/pelvic floor), Urge, Overflow (atonic/hypotonic bladder), Mixed
2. Pathophysiology: S2-S4 lesion so no signals to bladder (atonic bladder) + no signals to sphincter = mixed incontinence leading to overflow 3. Treatment: facilitate bladder emptying (indwelling catheter, CIC, prevent bladder overdistention and UIT, bladder tone may recover with time) |
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What are goals of management of neurogenic bladder? (4)
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Maintian normal renal function
Prevent UTI's Achieve continence Social acceptability |
