UI 2

Question 1

What are the 3 parts of an Artificial Urinary Sphincter?

Answer 1

• Cuff
• Reservoir
• Pump

Question 2

Artificial Urinary Sphincter - Cuff

• Cuff approach for men? / Placement?
• Cuff approach for women? / Placement?

Answer 2

• Men: Perineal approach
  
  • encircles urethra
• Women: Transvaginal or Transabdominal approach
  
  • placed at bladder neck

Question 3

Artificial Urinary Sphincter

• Where is the reservoir placed?

Answer 3

Posterior to abdominal wall

Question 4

Artificial Urinary Sphincter

• Where is the pump placed in men?
• Tends to move ___ leading to what?
• Pt instructed to do what?

Answer 4

• scrotum
• upward –> position too high to operate easily
• pull downward on pump daily to prevent encapsulation in high position

Question 5

Artificial Urinary Sphincter

• Where is pump placed in women?

Answer 5

Labia majora

Question 6

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

Answer 6

• 6
• 6

Question 7

Artificial Urinary Sphincter

• What should always be done prior to placing a urinary catheter??

Answer 7

• ALWAYS deactivate device (pump and lock in open position)

Question 8

Artificial Urinary Sphincter

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

Answer 8

Infection & Erosion

Question 9

Infection from Artificial Urinary Sphincter

• Occurs within the first __ months
• 3-5 % incidence
• ___, ___, ___ near pump or cuff
• 2 signs
• Which 2 bacteria?
• Tx?

Answer 9

• 2
• pain, edema, erythema
• leukocytosis, fever
• E. coli or Staph
• Explanation & Abx

Question 10

Erosion from Artificial Urinary Sphincter

• How is it prevented?
• 5% incidence
• More common if what?
• ___, ___, ___
• Explanation
• Re-implant after more than __ months later

Answer 10

• Avoid harsh perineal pressure (motorcycle, bicycle, horseback, sitting on hard surface w/o pad)
• pelvic radiation
• dysuria, hematuria, recurrent infections
• 3

Question 11

Urge or overactive?

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

Answer 11

Urge incontinence

Question 12

Urge or Overactive?

• urinary urgency, usually associated w/ frequency

Answer 12

Overactive bladder

Question 13

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

Answer 13

• Behavioral Therapy
• Estrogen
• Anticholinergic med
• Beta adrengergic med

Question 14

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

Answer 14

• Neuromodulation (sacral, tibial) w/ needle
• Botulinum

Question 15

3 “surgical” tx for urge incontinence / overactive bladder

Answer 15

• augmentation enterocystoplasty
• autoaugmentation
• urinary diversion

Question 16

Estrogen tx for urge incont / overact bladder

• topical vaginal
• Contraindicated if hx of what 7 things?

Answer 16

• venous thrombosis
• PE
• CVA
• MI
• estrogen dependent cancer (breast)
• abnormal genital bleeding
• liver dysfunction

Question 17

Which med for urg incont / overact bladder?

• Inhibit the muscarinic cholinergic receptors
• Decrease detrusor muscle contractions

Answer 17

Anticholingergic

Question 18

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

Answer 18

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

Question 19

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

Answer 19

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

(DDD-BCH)

Question 20

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

Answer 20

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

(For both meds, extended is preferred)

Question 21

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

Answer 21

• Fesoterodine
• Darifenacin
• Solifenacin
• Trospium

Question 22

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?

Answer 22

Beta Adrenergic Agonist

• increases cAMP, decreases Ca
• monitor for increased BP

Question 23

Minimally Invasive tx of Urge / Overactive w/ Botulinum Toxin

• injected cystoscopically into ___ muscle
• effects last __ to __ months

Answer 23

• detrusor
• 3 - 12

Question 24

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?

Answer 24

• S3 afferent
• S3
• 2 / internally

Question 25

**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.

Answer 25

* In office * superior to / posterior to medial malleolus of either leg * 30 / 12

Question 26

**Augmentation enterocystoplasy surgical tx for urge / overactive** * Bladder dome opened * Detubularized intestinal segment appended to \_\_\_ * Increases \_\_\_\_\_\_ * Decreases ____ & \_\_\_\_

Answer 26

* bladder * bladder capacity * intravesical voiding pressure & incontinence

Question 27

****_Auto_**augmentation enterocystoplasy surgical tx for urge / overactive** * Detrusor muscle of dome of bladder incised * ____ remains intact * Bladder capacity \_\_\_ * Intravesical pressures \_\_\_\_ * Decreased incontinence

Answer 27

* urothelium * expands * lower

Question 28

**Urinary Diversion surgery to tx urge / overactive** * Urine bypasses bladder via \_\_\_\_

Answer 28

Ileal conduit