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Flashcards in UI 2 Deck (28)
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1
Q

What are the 3 parts of an Artificial Urinary Sphincter?

A
  • Cuff
  • Reservoir
  • Pump
2
Q

Artificial Urinary Sphincter - Cuff

  • Cuff approach for men? / Placement?
  • Cuff approach for women? / Placement?
A
  • Men: Perineal approach
    • encircles urethra
  • Women: Transvaginal or Transabdominal approach
    • placed at bladder neck
3
Q

Artificial Urinary Sphincter

  • Where is the reservoir placed?
A

Posterior to abdominal wall

4
Q

Artificial Urinary Sphincter

  • Where is the pump placed in men?
  • Tends to move ___ leading to what?
  • Pt instructed to do what?
A
  • scrotum
  • upward –> position too high to operate easily
  • pull downward on pump daily to prevent encapsulation in high position
5
Q

Artificial Urinary Sphincter

  • Where is pump placed in women?
A

Labia majora

6
Q

Artificial Urinary Sphincter

  • Cuff left in open position (deactivated) for __ weeks post-op to allow healing w/o urethral pressure
  • Return in __ weeks for activation & instruction
A
  • 6
  • 6
7
Q

Artificial Urinary Sphincter

  • What should always be done prior to placing a urinary catheter??
A
  • ALWAYS deactivate device (pump and lock in open position)
8
Q

Artificial Urinary Sphincter

  • Be alert to signs and sxs of complications, especially which 2??
A

Infection & Erosion

9
Q

Infection from Artificial Urinary Sphincter

  • Occurs within the first __ months
  • 3-5 % incidence
  • ___, ___, ___ near pump or cuff
  • 2 signs
  • Which 2 bacteria?
  • Tx?
A
  • 2
  • pain, edema, erythema
  • leukocytosis, fever
  • E. coli or Staph
  • Explanation & Abx
10
Q

Erosion from Artificial Urinary Sphincter

  • How is it prevented?
  • 5% incidence
  • More common if what?
  • ___, ___, ___
  • Explanation
  • Re-implant after more than __ months later
A
  • Avoid harsh perineal pressure (motorcycle, bicycle, horseback, sitting on hard surface w/o pad)
  • pelvic radiation
  • dysuria, hematuria, recurrent infections
  • 3
11
Q

Urge or overactive?

  • episodic involuntary loss of urine, immediately preceded by or associated w/ urgency
A

Urge incontinence

12
Q

Urge or Overactive?

  • urinary urgency, usually associated w/ frequency
A

Overactive bladder

13
Q

4 “non-invasive” tx for urge incontinence / overactive bladder

A
  • Behavioral Therapy
  • Estrogen
  • Anticholinergic med
  • Beta adrengergic med
14
Q

2 “minimally invasive” tx for urge incontinence / overactive bladder

A
  • Neuromodulation (sacral, tibial) w/ needle
  • Botulinum
15
Q

3 “surgical” tx for urge incontinence / overactive bladder

A
  • augmentation enterocystoplasty
  • autoaugmentation
  • urinary diversion
16
Q

Estrogen tx for urge incont / overact bladder

  • topical vaginal
  • Contraindicated if hx of what 7 things?
A
  • venous thrombosis
  • PE
  • CVA
  • MI
  • estrogen dependent cancer (breast)
  • abnormal genital bleeding
  • liver dysfunction
17
Q

Which med for urg incont / overact bladder?

  • Inhibit the muscarinic cholinergic receptors
  • Decrease detrusor muscle contractions
A

Anticholingergic

18
Q

5 contraindications of anticholinergic med for urge incont / overact bladder?

A
  • Uncontrolled narrow angle glaucoma
  • myasthenia gravis
  • intestinal obstruction
  • gastric retention
  • urinary retention
19
Q

What are the 6 SE of anticholinergic med for urge incont / overactive bladder?

A
  • Xerostomia (dry mouth)
  • constipation
  • dizziness
  • drowsiness
  • blurry vision
  • HA

(DDD-BCH)

20
Q

What are the 2 anticholinergic meds and what forms do they come in?

A
  • Oxybutynin
    • immediate release
    • extended release
    • patch
    • gel
  • Tolterodine
    • immediate release
    • extended release

(For both meds, extended is preferred)

21
Q

Besides Oxybutynin & Tolterodine, what other 4 anticholinergics are there?

A
  • Fesoterodine
  • Darifenacin
  • Solifenacin
  • Trospium
22
Q

What med for urge incont / overact bladder?

  • Mirabegron
  • Stimulates Beta-3 receptors in bladder
  • relaxes detrusor
  • higher bladder capacity
  • Does what to cAMP and intracellular Ca?
  • Monitor what?
A

Beta Adrenergic Agonist

  • increases cAMP, decreases Ca
  • monitor for increased BP
23
Q

Minimally Invasive tx of Urge / Overactive w/ Botulinum Toxin

  • injected cystoscopically into ___ muscle
  • effects last __ to __ months
A
  • detrusor
  • 3 - 12
24
Q

Minimally Invasive tx for urg/overactive w/ Sacral Neuromodulation (Interstim)

  • Electrical stimulation of __ ___ nerve to modify voiding reflex
  • Stage 1: electrode is placed near __ nerve. Connected to a generator worn on belt and activated
  • Stage 2: if __ week trial successful, generator is placed where?
A
  • S3 afferent
  • S3
  • 2 / internally
25
Q

Minimally invasive tx for urge / overactive w/ Posterior Tibialis Nerve Stimulation (PTNS)

  • Where is procedure done?
  • Electrode placed where?
  • Electrical stimulation for __ mins weekly for __ weeks.
A
  • In office
  • superior to / posterior to medial malleolus of either leg
  • 30 / 12
26
Q

Augmentation enterocystoplasy surgical tx for urge / overactive

  • Bladder dome opened
  • Detubularized intestinal segment appended to ___
  • Increases ______
  • Decreases ____ & ____
A
  • bladder
  • bladder capacity
  • intravesical voiding pressure & incontinence
27
Q

Autoaugmentation enterocystoplasy surgical tx for urge / overactive

  • Detrusor muscle of dome of bladder incised
  • ____ remains intact
  • Bladder capacity ___
  • Intravesical pressures ____
  • Decreased incontinence
A
  • urothelium
  • expands
  • lower
28
Q

Urinary Diversion surgery to tx urge / overactive

  • Urine bypasses bladder via ____
A

Ileal conduit