Term
| what does urinary continence depend on at any age? |
|
Definition
| the integrity of lower UT function as well as the presence of adequate mentation, mobility (to the bathroom), motivation, and manual dexterity. |
|
|
Term
| why is urinary incontinence a major problem for the elderly? |
|
Definition
| urinary incontinence predisposes pts to perineal rashes, pressure ulcers, UTIs, urosepsis, falls and fractures. it is associated with embarrassment, stigmatization, isolation, and depression. |
|
|
Term
| what is stress incontinence? |
|
Definition
| the involuntary loss of urine through an intact urethra due to an *increase in intra-abdominal pressure (coughing, sneezing, laughing, getting out of a chair). it is of sufficient quantity to be socially embarassing. |
|
|
Term
| what is the most common cause of involuntary loss of urine in women? |
|
Definition
|
|
Term
| what does urinary stress incontinence need to be differentiated from? |
|
Definition
| urge, neurogenic (DM, MS, etc), ectopic ureteral orfice (congential, outside the vagina), senile urethritis (less estrogen), urethral diverticulum (outpouching through muscle, possibly related to scarring, obstruction, previous infection, vaginal deliveries, etc), cystitis (recurrent infections), urethritis, and bladder neoplasm (takes up space along w/stones) |
|
|
Term
| what characterizes urge incontinence? |
|
Definition
| "can't get there in time" (loss of urine which occurs following the sensation/desire to void) |
|
|
Term
| what characterizes mixed incontinence? |
|
Definition
| can't get there in time along with involuntary urination due to: coughing, sneezing, laughing, getting out of a chair. treatment of one cause may resolve the other, cause the other, or neither could resolve. |
|
|
Term
| what characterizes transient incontinence? |
|
Definition
| incontinence which comes and goes (such as that which accompanies an infection) |
|
|
Term
| what characterizes overflow incontinence? |
|
Definition
| this is often seen in men w/BPH. BPH may cause incomplete emptying of the bladder to the point where the pt is only peeing out what is overflow from the full bladder. |
|
|
Term
| what % of young healthy women admit to occasional mild stress incontinence? |
|
Definition
|
|
Term
| what condition in women is highly associated with stress incontinence? |
|
Definition
| multiple vaginal deliveries and menopause |
|
|
Term
| how is urinary incontinence diagnosed? |
|
Definition
|
|
Term
| can pts w/pure urge incontinence be cured by sx? what is the caveat here? |
|
Definition
| no - however 1/3 of pts w/sugically curable stress urinary incontinence have urgency on initial presentation (need to differentiated) |
|
|
Term
| what kinds of things should the dr look for in a physical exam for incontinence pts? how should this be carried out? |
|
Definition
| cystocele (outpouching of the bladder - may be connected to a rectocele), rectocele or enterocele (everything falls into vagina). the physical exam should be done bimanually, checking the abdomen, rectum and pelvis. S2,S3,S4 dermatomes of the perineum need to be evaluated as well. |
|
|
Term
| what studies can be done to diagnose the cause of urinary incontinence? |
|
Definition
| post-void residual (check bladder fullness after urination via catheter), cystometrogram (evaluate bladder's storage/emptying capacity), marshall/q-tip test (get pt to cough w/full bladder in lithotomy/standing position to dx stress incontinence), cystoscopy (r/o bladder pathology: neoplasm, diverticulum, calculi), complete urodynamics (how well bladder holds/empties), and leak-point pressure (checks neurologic integrity of bladder/urethra) |
|
|
Term
| what can the post-void residual study tell you |
|
Definition
| if there is significant residual - which may be a sign of a neurogenic bladder dysfunction or possible cystocele |
|
|
Term
| what can the cystometrogram study tell you? |
|
Definition
| a cystometrogram can evaluate the bladder's storage/emptying capacity and allows the dr to differentiate between stress and urge incontinence. the bladder is filled via catheter and then the pt is questioned about their sensation to void. pts w/smaller bladder capacity are more prone to urge incontinence (smaller capacity could be due to a thickened detrussor muscle caused by chronic urge ignoring). usually there is an urge to void at 150-200 cc and a second at 350 cc. total capacity is ~400-500 cc. |
|
|
Term
| what can the marshall/q tip test tell you? |
|
Definition
| if the pt has stress incontinence. the pt is tested in the lithotomy and erect position w/a full bladder and asked to cough. a leak in either position is positive and is thus surgically correctable. |
|
|
Term
| what is necessary for the eventual surgical correction of urinary stress incontinence? |
|
Definition
| visual demonstration of a simultaneous loss of urine w/the rise and fall of abdominal pressure during coughing (as w/marshall test) |
|
|
Term
| what are the treatments for urge incontinence? |
|
Definition
| treat underlying position (cause of coughing etc), anticholinergics (oxybutnin, tolteridine - relax detrussor muscle), behavior modification, electrical stimulation and biofeedback (if pt doesn't feel the need to urinate) |
|
|
Term
| what are the treatments for stress incontinence? |
|
Definition
| *correct factors that accentuate stress urinary incontinence (obesity, chronic pulmonary problems, recurrent UTIs), kegel exercises (exercise pubococcygeus muscles), pessaries (objects which elevate the urethrovesical angle), pharmacologics (not very effective - anticholinergics, sympathomimetic agents, tricyclic antidepressants, and duloxetine), minimally invasive procedures (peri-urethral collagen injections), and surgery (elevate bladder neck behind the symphysis pubis - sling) |
|
|
Term
| what are some benign urethral lesions? |
|
Definition
| urethral caruncle (fleshy piece of tissue that typically sits at “6 o’clock position” when looking at urethral meatus - need to distinguish from a condyloma), cysts, and condyloma accuminata (viral warts - do have malignant potential) |
|
|
Term
| how are condyloma accuminata treated? |
|
Definition
| topical chemotherapy (podophylin, aldara, condylox), electrocautery, cryo, and laser therapy |
|
|
Term
| what characterizes urethral CA once it is noticed? |
|
Definition
| generally it is aggressive by that point |
|
|
