Urinary incontinence Flashcards Preview

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Flashcards in Urinary incontinence Deck (16)
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1
Q

what is the cotton swab test?

A

insert a lube’d cotton swab into urethra to the level of the urethrovesical junction. Ask pt to strain as if urinating. Should see a change in cotton swab angle < 30 degrees, but if bladder neck is hypermobile, it will be more than this.

2
Q

what are the 4 types of incontinence?

A

stress
urge
total
overflow

3
Q

what is total incontinence?

A

continuous urine leakage due to urinary fistula

4
Q

what is overflow incontinence?

A

overdistension of bladder 2/2 poor detrusor ctr’ns => leaking

5
Q

RFs for stress incontinence?

A

conditions causing pelvic relaxation
(vaginal births, aging, genetics)
Conditions causing chronic increases in intraab’l P
(constipation, chronic cough, chronic heavy lifting, ob)
Conditions that weaken the urethral closing mechanism
(ES def’y, scarring, meds, denervation)

6
Q

tx for stress incontinence?

A

Kegel exercises
Pessaries
d/c’ing certain meds, regulating fluid intake, bladder training/biofeedback
topical ES
surgery - urethropexy, suburethral sling

7
Q

what is detrusor instability?

A

urge incontinence. Involuntary detrusor contractions, usually idiopathic, can be 2/2 neurologic disorders, infection, bladder stones, suburethral diverticulum

8
Q

CP of detrusor instability

A

urgency
frequency
stress incontinence
nocturia

9
Q

tx of detrusor instability:

A
Kegels
bladder tr (regular voiding schedule), biofdbk
hypnosis, psychotherapy
oxybutinin (anti-ACh)
tolterodine (SMC relaxant)
imipramine
**medical therapy, not surgical**
10
Q

what is most common cause of urinary fistulas?

A
ob trauma  (seen more in developing countries)
pelvic radiation or surgery (in dvp'd countries)
11
Q

which surgeries account for most of vesicovaginal fistula formation?

A

simple ab’l hysterectomy

vag hyst

12
Q

how to eval for vesicovaginal fistula?

A

instill methylene blue dye into bladder, see if it comes out onto tampon or pad.

13
Q

how to eval for utererovaginal fistula?

A

inject indigo carmine IV. It will be filtered by kidneys, and if fistula is present, it will be on tampon or pad. But methylene blue test will be negative.

14
Q

tx of urinary fistula?

A

surgery

15
Q

causes of overflow incontinence?

A
fecal compaction
meds
neuro'c disorders
post-op bladder distension 2/2 epidural anesth 
post-op urethral obstruction
16
Q

tx of overflow incontinence

A

prazosin, terazosin (relax urethra)
diazepam, dantrolene (striated m. relaxant)
bethanechol (ACh agonist)
intermittent self-cath
surgical correction if obstruction is cause
foley catheter for 24-48h if post-op urinary retention