X hits on this document

131 views

0 shares

0 downloads

0 comments

34 / 54

URINARY INCONTINENCE

Notes

STRESS INCONTINENCE

consider medical causes, e.g. infection, delirium, depression, medications

Etiology birth process causing denervation of urethra hypoestrogen of menopause causing decreased vascularity, urethral muscle atrophy usually lose only a few drops of urine occurs with increased intra-abdominal pressure (i.e. sneezing, coughing) best type of incontinence on which to operate (best success)

Mechanism proximal urethra drops below pelvic floor and transmission of increased intra-abdominal pressure is not distributed evenly • bladder pressure > urethral pressure

Degrees mild - sneezing, coughing moderate - leaks when walking severe - leaks when standing up

D i a g n o s i s b y c l i n i c a l p r e s e n t a t i o n s t r e s s t e s t d e m o n s t r a t e u r i n a r y i n c o n t i n e n c e c y s t o s c o p y u r o d y n a m i c s .

Treatment medical K e g e l s e x e r c i s e s ( p e l v i c d i a p h r a g m e x e r c i s e s ) e s t r o g e n f o r a t r o p h i c u r e t h r i t i s s u r g i c a l v a g i n a l l y o r a b d o m i n a l l y s e e U r o l o g y N o t e s

TOTAL INCONTINENCE

constant loss of urine vesico-vaginal fistula • previous pelvic surgery and radiation account for 95%

Diagnosis instillation of methylene blue dye into bladder or IV indigo-carmine dye with leakage of dye into vaginal packing

Treatment surgical

URGENCY INCONTINENCE

l o s s o f u r i n e a s s o c i a t e d w i t h a n u n c o n t r o l l a b l e u r g e t o v o i d s e c o n d a r y t o d e t r u s o r i n s t a b i l i t y o r d y s s y n e r g i a i n v o l u n t a r y c o n t r a c t i o n a n d o v e r a c t i v i t y o f d e t r u s o r c h r o n i c i r r i t a t i o n o r i n f e c t i o n ( i . e . i n t e r s t i t i a l c y s t i t i s ) f u n c t i o n a l i m p a i r m e n t ( i . e . m o b i l i t y p r o b l e m s ) U T I s c o m m o n see Urology notes for figure of bladder innervation

Diagnosis by clinical presentation urodynamics • uninhibited contractions if unstable bladder • small bladder capacity if irritable bladder

Treatment bladder training (timed voiding patterns) anticholinergics (propantheline) • inhibits the parasympathetically innervated detrusor muscle

Gynecology 34

MCCQE 2000 Review Notes and Lecture Series

Document info
Document views131
Page views131
Page last viewedSat Dec 03 20:22:10 UTC 2016
Pages54
Paragraphs1202
Words31307

Comments