UI 1

Question 1

What are the 6 types of Urinary Incontinence?

Answer 1

1. Stress UI
2. Urge UI
3. Mixed
4. Unaware (unconscious)
5. Nocturnal enuresis
6. Continuous

Question 2

What are the 5 underlying pathophysiologies of UI?

Answer 2

• Intrinsic sphincteric deficiency (ISD)
• Urethral hypermobility
• Detrusor overactivity
• Low bladder compliance
• Urinary retention

Question 3

Transient Causes of UI

Answer 3

DIAPPERS

• Delirium
• Infection
• Atrophic vaginitis
• Pharmaceuticals/Polypharmacy
• Psychological
• Excessive Urine Production
• Restricted Mobility
• Stool Impaction / Constipation

Question 4

2 exam findings on rectal exam for UI

Answer 4

• stool impaction
• bulbocavernosal reflex

Question 5

5 PE components for UI

Answer 5

• Female: pelvic
• Male: prostate
• Perineal sensation
• Rectal exam: stool impaction , bulbocavernosal reflex
• LE: edema

Question 6

3 components of PE for pelvic exam of female for eval of UI

Answer 6

• Vaginal epithelium: atrophic vaginitis
• Cotton swab test (place cotton swab in urethra, change of 30 degrees w/ strain = urethral hypermobility)
• Cough test (observe for leaking w/ cough)

Question 7

5 studies

Answer 7

• UA / culture (glucosuria, infection)
• Voiding diary (voids, incontinence, fluid consumption, BMs)
• Post-void residual: retention
• Cytoscopy: stricture, tumor
• Urodynamic study

Question 8

3 imaging studies for UI

Answer 8

• Voiding cystourethrogram
• Pelvic Imaging (MRI)
• Neurologic Directed Imaging

Question 9

What are the tx for UI caused by these?

• Delirium
• Infection
• Atrophic Vaginitis
• Pharmaceuticals
• Psychological
• Excessive UOP
• Restricted mobility
• Stool impaction/constipation

Answer 9

• Delirium –> tx underlying cause
• Infection–> abx
• Atrophic Vaginitis–> topical vaginal estrogens
• Pharmaceuticals–> elimination/adjustments
• Psychological–>psych referral
• Excessive UOP–>tx/manage cause, alter timing of fluid intake/diuretics, elevation of LE
• Restricted mobility–> bedside commode / urinal
• Stool impaction/constipation–> bowel management

Question 10

Tx of Urinary Retention?

(4)

Answer 10

• tx to empty bladder
  
  • avoid certain OTC meds (cough/cold meds)
  • Catheterization
  • BPH medication
  • Surgery

Question 11

Test and Tx for Continuous Incontinence caused by vesicovaginal fistula

Answer 11

• Test: Pyridium test: place tampon in vagina, give Pyridium, if tampon is orange the pt has fistula.
• Tx: surgery

Question 12

3 Non-Invasive Tx for Female Stress Urinary Incontinence (SUI)?

Answer 12

• Behavioral Therapy
• Medication
• Continence Devices (pessary, catheter)

Question 13

Minimally Invasive Tx for Female SUI

Answer 13

Bulking Agents

Question 14

4 Surgical Tx for Female SUI

Answer 14

• Anterior Repairs
• Suspensions
• Artificial Urinary Sphincter
• Sling procedures

Question 15

4 tx options for Non-Invasive Behavioral Therapy for Female SUI

Answer 15

• Pelvic Floor Muscle Training (PFMT)
• ​Avoidance of constipation
• Elevation of edematous lower extremities (helpful for night time incontinence)
• Timed voiding to prevent leakage

Question 17

2 components of bladder training for female SUI

Answer 17

• Gradually increase time between voids
• Suppress urge w/ breathing exercises, mental imagery, distraction, or pelvic floor muscle contractions

Question 18

Tx for what?

• Fluid intake modification: drink fluids earlier in day, avoid right before bed time
• Dietary modification: avoid bladder irritants (caffeine, ETOH, spicy foods, acidic foods)
• Weight loss (decrease in abd pressure / pressure on bladder)

Answer 18

Tx for Female SUI

Question 19

Tx for Female SUI (non-invasive)

• Avoidance of ____
• Elevation of edematous LE during what time of day?
• Compression stockings
• Void before ____

Answer 19

• constipation
• PM prior to hs to mobilize fluid
• going to sleep to avoid nocturia

Question 20

Tx for Female SUI : Pelvic Floor Muscle Training (PFMT)

• Indicated for which 3 types of UI?
• Maximal isometric contractions of pelvic floor muscles
• Contract for __ to __ seconds, relax
• __ repetitions
• __ sets / day
• Teaching by professional

Answer 20

• SUI, UUI, Mixed UI
• 6-8
• 10 reps
• 3 sets

Question 21

Which medication for tx of femle SUI?

• increases muscle tone of urinary sphincter
• Not FDA approved for this indication
• Pseudoephedrine, ephedrine, imipramine

Answer 21

Alpha Agonists

Question 22

7 Contraindications of Alpha Agonists (Pseudoephedrine, ephedrine, imipramine)

Answer 22

• cardiac disease
• uncontrolled HTN
• narrow angle glaucoma
• hyper-thyroidism
• DM
• MAOI use (monoamine oxidase inhibitors)
• at risk for seizures

Question 23

Which medication for tx of Female SUI?

• Serotonin & NE reuptake inhibitor
• Nausea
• Higher than expected rate of suicide
• Not FDA approved for this indication

Answer 23

Duloxetine

Question 24

What are the 3 “continence devices” for tx of female SUI?

Answer 24

• Pessary (taco time) - changed monthly
• Indwelling urinary catheter (urethral or suprapubic)
• Urethral occlusive device

Question 25

**Tx for Female SUI : Bulking Agents** * Injection of material adjacent to the proximal \_\_\_/\_\_\_\_ * Coats the \_\_\_\_\_\_\_\_ * Increases bladder outlet resistance * Generally done \_\_\_\_\_\_ * Single or multiple txs?

Answer 25

* urethra/bladder neck * urethral mucosa * transurethrally * multiple

Question 26

**Tx for Female SUI : Bulking Agents** * 4 types of agents? * Skin test to check for \_\_\_\_ * Can migrate to \_\_\_ * ____ visible on x-rays

Answer 26

* collagen, graphite, calcium hydroxyapatite, silicone * allergic rxn * lymphatic system * calcium

Question 27

4 types of surgeries for tx of Female SUI?

Answer 27

* Anterior repair * Suspension * Artificial Urinary Sphincter * Sling

Question 28

**Which surgery for Female SUI?** * _____ fascia imbricated ____ to support the bladder

Answer 28

**Anterior Repair** * pubocervical / posteriorly

Question 29

**Which surgery for Female SUI?** * Marshall-Marchetti-Krantz (MMK) - periurethral * Burch - perivesical

Answer 29

Suspension

Question 30

In which patients would you use a "sling" surgery for tx of Female SUI?

Answer 30

pts w/ urethral hypermobility (\>30 degrees)

Question 31

**Tx of Female SUI** * like a "hammock" under urethra * autologous fascia * allograft * xenograft (porcine, bovine) * synthetic

Answer 31

Sling

Question 32

**Surgery for Female SUI** * If there is overcorrection, urinary retention may require intermittent _____ (temporarily) * Possibility of sling erosion into the \_\_\_, \_\_\_, \_\_\_ * leading to sxs including....

Answer 32

* catheterization * vagina, urethra/bladder * dyspareunia, vag pain, vag discharge, vag bld * dysuria, hematuria, urinary urgency, urinary freq, recurrent UTI, recurrent SUI

Question 33

What tx of female SUI is considered "minimally invasive?"

Answer 33

Bulking Agents