Urinary incontinence

Question 1

what is epi for stress incontinence

Answer 1

• almost only women

- can be any age

Question 2

what are 3 important parts of bladder innervation

Answer 2

1. Parasympathetic (S2-4) (muscarinic-r) - excite bladder and relax urethra
2. Sympathetic (T10-L2)- inhibit bladder body (beta 3 receptors) , excite bladder base and urethra (alpha 1)
3. Somatic - stim of the pudendal nerve exites the external striated urethral sphincter

Question 3

what are afferent, efferent, and central pathways for storage phase

Answer 3

afferent - low level activity - bladder not full
efferent - sphyincter contraction, detrusor relax
central - spinal relfexes

Question 4

what are afferent, efferent, and central pathways for voiding phase

Answer 4

afferent - high level activity - bladder full
efferent - inhibit sphincter, avtivate detrusor
central - spino-bulbospinal

Question 5

3 main types of incontinence

Answer 5

1. failure to store
2. failure to empty
3. mixed

Question 6

2 types of failure to store

Answer 6

1. urgency - overactive bladder

2. stress - outlet incompetence

Question 7

2 types of failure to empty

Answer 7

1. due to hypotonic bladder
2. outlet - obstruction
3. mixed

Question 8

def. overactive bladder

Answer 8

URGENCY with ot without incontinence

- wet or dry type

Question 9

mech. of overactive bladder

Answer 9

• UMN disease of bladder

- detrusor muscle contract spontaneously

Question 10

mech. stress urinary incontinence

Answer 10

• abdo pressure exceeds the sphintcer
• mostly women
• parity, obesity, COPD, constipation

Question 11

5 basic parts to exam

Answer 11

1. Hx
2. Phx
3. urinalysis
4. bloods
5. post void residual

Question 12

4 times to use scope

Answer 12

1. hematuria
2. other assoc. Sx
3. bladder CA risk
4. not respnding to ther

Question 13

2 spincters and how they’re controlled

Answer 13

1. internal - smooth muscle - involuntary

2. external - striated - voluntatry

Question 14

2 Tx for incontience post-prostatectomy

Answer 14

1. artificial phincter

2. male sling

Question 15

what is the effect of stroke

Answer 15

can cause detrusor overactivity

- still have good sphincter control

Question 16

what is effect of MS

Answer 16

can also cause detruser overactivity

Question 17

5 parts of behavioiual therapy

Answer 17

1. physio
2. fluid and diet mods
3. timed voiding
4. urge supression
5. voiding diary

Question 18

2 bladder meds

Answer 18

1. anti-muscarinics

2. B3- agonists

Question 19

3 surgical options

Answer 19

1. botox
2. neuromodulation
3. bladder augmentation

Question 20

4 types of bladder dysfunction

Answer 20

1. stress incontinence
2. cystocoel - bladder into vag
3. rectocoel - rectum into vag
4. enterocoel - bowel into vag

Question 21

3 options for prolapse

Answer 21

1. burch
2. sling
3. periurethral injections

Question 22

3 general patterns of SCI and implications

Answer 22

1. above T6 - above sympathetics
2. T6-L1 - suprasacral
3. below L1/2

Question 23

issue in SCI above sacral spinal cord

Answer 23

• neurgenic detrusor over active
• absent sensation below
• smooth sphinct synergia
• smooth sphint dysenergia

Question 24

when does autonomic dysreflexia occur

Answer 24

• SCI T6 or up

- need some sort of stim