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46 Cards in this Set
- Front
- Back
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detrusor overactivity causes what
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urgency, frequency, nocturia, incontinence
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BPH causes what
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outlet obstruciton, freq, urgency, nocturia, urge overflow incont
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more output later in the day causes what
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nocturia
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atrophic vaginitis causes what
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decreased urethral mucosal seal, irritation, stress incontinence and UI
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increased PVR causes what
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freq, nocturia, UI
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decreased total bladder capacity causes what
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urge, noct, UI and freq
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decreased detrusor contractility causes what
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decreased flow rate, elevated PVR, and hesitency
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the SNS controls what in the bladder
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alpha - internal sphincter contraction T11 - L2
beta - bladder relaxation T11-L2 |
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the PNS controls what in the bladder
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cholinergic, bladder contraction
S2 - S4 |
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what does the somatic nerve control in the bladder
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external sphincter contraction
S2 - S4 |
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what part contracts the detrusor and inhibits relaxation
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pns
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what are some risk factors for UI
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DJD
delirium, decreased cognition meds - diuretics smoking fecal impaction low fluid intake enviromental barriers high impact physical activity obesity chronic disease- stroke, MS, DM estrogen depletion pregnancy |
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what medications have a potential for UI
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antidepressents, psychotics, antiparkinson
sedatives antihistamines anticholinergics narcotics alcohol diuretics aces, CCB, alpha, beta blockers cholinergics alpha, beta agonists |
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stress incontinence peaks when
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childbearing 20-40s
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when does urge incontinence peak
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menopause
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this is the involuntary loss of urine associated with a strong sensation to void
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urgency
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this is urethral sphincter failure, increased abdominal pressure
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stress
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this is overdistension of the bladder
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overflow
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this is chronic impairment
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functional
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this is reversible, common in hospitalized patients
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transient
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what are transient causes of UI
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delirium
infection atrophic vaginitis medications psychological disorder CHF, endocrine disorder restricted mobility stool impaction |
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this is caused by involuntary detrusor contraction
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urge
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what are some CNS inhibition causes of urge
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neuro - stroke, ms, sprinal cord lesions, tumors, parkinsons
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what are some afferent stimulation from the bladder causes of urge
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lower uti
atophic fecal impact prolapsed uteris bph |
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what are some impaired detrusor contractility in urge
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dm
neuropathy stenosis spinal cord injury |
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what are symptoms of urge
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low urine, abrupt strong desire to void
loss of urine on way to bathroom nocturia wet bed at night weak bladder feeling |
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what are cause of stress UI
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weak bladder neck and urethra
weak intrinsic urethral sphincter - alpha blockers pregnancy, radiation, damage during urological procedure, diuretics |
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this UI is a reduction in the force and caliber of urinary stream,, sensation of incomplete void
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overflow
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what is outlet obstruction in overflow ui
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bph - urine retention or severe prolapse or fecal impaction
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wat is dysfunctional bladder contractility in overflow ui
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dm
alcoholic neuropathy meds with anticholinergics narcotics muscle relaxants |
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this is loss of urine that is unrelated to urinary tract disorders
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functional incontinence, diagnosed by exclusion
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causes of functional incontinence
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dementia, depression, delirium
immobility cannot get to bathroom, undress self decreased awareness to void |
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what is mixed UI
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both urge and stress
increased in elderly women id most bothering symptom |
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what ROS would you do for UI
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medical
surgical urological gyn neurological sexual function social/living enviroment |
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what medical and neurological symptoms are you looking for in UI
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neuro - dementia, delirium, stroke, parkinsons, peripheral neuropathy
medical: HF, orthostatics, peripheral edema, abdominal mass |
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what are the best diagnostic tests for UI
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3 day voiding diary - focus on first morning and night voids because of how long you can hold urine and the amount
urine with culture blood glucose creatnine and BUN |
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what are the results of a PVR test
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<50ml normal
50-100 weakness or obstruction 100-200 abnormal >200 = refer |
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when would you order a PVR test in UI
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suspect UTI, neurological disease, prolapse
overflow UI before surgery |
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what are the 3 areas of management for UI
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behavioral
pharmacology surgical |
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what are some lifestyle changes for UI
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modify diet - no acidic foods, sweetners, decrease fluid intake before bed, no caffeine, milk products, sugar, honey
reduce weight regular bowel function quit smoking |
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what are some behavioral modifications for urge and stress incontinence
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bladder training - every 2 hours
bladder diary routine toileting - voiding time table kegels - PME electrical stimulation biofeedback |
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what medications are used in urge incontinence
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antimuscarinic and anticholinergics
ditropan detrol tospium SE: dry mouth, constipation, dry eyes, blurred vision, HA, drowsy and diarrhea Contraindication: arrythmia, glaucoma, hepatic disease or abdominal pain |
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what medications are used for stress incontinence
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alpha agonists - pseudoephedrine, estrogen cream
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what surgeries are for stress incontinence
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pessaries
bladder neck suspension anterior vaginal repair sling procedure periurethral debulking injection artificial sphincter implantation Must have UT imaging, void diary, cystoscopy, urodynamics, PVR, ua and culture |
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what medications are for obstruction from BPH
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Alpha blockers
Terazosin, Tamsulosin, Doxaosin relax smooth muscle in the bladder, prostate 5alpha reductase inhibitors Advodart, Proscar decrease prostate size by inhibiting DHT Can use combo of both |
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when would you have surgery for stress or obstructive UI
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stress- if behavioral does not work
obstructive - pathology suspected |
