Urology- Urinary Incontinence

What is the normal capacity of the bladder?

400-600 mL

What is stress incontinence?

loss of urine associated w/ activities that inc intra-abdominal pressure

(coughing, sneezing, laughing, jumping, running, heavy lifting)

What causes stress incontinence?

poor urethral sphincter function, laxity in the pelvic floor and poor support of the vesicourethral sphincter

What are RF for stress incontinence?

pregnancy, pelvic floor trauma, hx of pelvic/prostate surgery

What is the tx for stress incontinence?

No meds

Non-surg: pelvic floor therapy (Kegels), Pessaries

Surg: (sling, bladder neck suspension, transurethral bulking agent, artificial urinary sphincter)

What is the MC type of surgery to correct stress incontinence?

*also less invasive

Sling procedure

What is urge incontinence?

overactive bladder - uninhibited bladder contraction d/t detrusor overactivity

How does urge incontinence present?

sudden intense urge to void followed by involuntary loss of urine; unrelated to position or activity

What is the tx for urge incontinence?

Meds: anticholinergics (oxybutynin), Tamsulosin, Beta-3 agonist (Myrbetriq, Gemtesa)

Non-surg: dietary changes, manage constipation, behavior modification therapy

Surg: botox, nerve stimulator

What is the overflow incontinence?

incomplete bladder emptying leading to an “overflow” leakage of urine; MC in men

What causes overflow incontinence?

bladder outlet obstruction (BPH, urethral strictures) or peripheral nerve damage (DM)

How does overflow incontinence present?

constant/frequent dribbling, poor bladder compliance, frequency, urgency, urinary retention

What is the tx for overflow incontinence?

intermittent cath, tx underlying condition, sacral nerve stimulation

What is mixed incontinence?

leakage associated w/ urgency and w/ exertion (combo of stress and urge)

What is uroflowmetry?

non-invasive assessment of the free flow of urine voided per unit time

What is cystometry?

measure detrusor pressure during continuous filling of the bladder

What is a pressure flow study?

measures pressure generated by the detrusor muscle and resultant flow

What PVR is considered normal?

< 50 mL

What PVR is considered abnormal and may be suggestive of either detrusor weakness or obstruction?

> 200 mL

What is a urethral pressure profile?

measures urethral length and competence

What is EMG?

evaluates the electrical potentials generated by the pelvic floor muscles

When should you refer to urology?

complicated UI that cannot be controlled, pelvic pain, recurrent UTIs, abn PSA or prostate exam, hematuria, prior pelvic radiation, neurologic disease

What is the MCC of stress incontinence in males?

Prostate surgery

Who is urinary incontinence most likely to affect?

F > M, MC in older pts; peak around menopauses, rises steadily btwn 60-80 yo

What is hematuria a sign of?

CA until proven otherwise

What pt education needs to be done for urinary incontinence?

avoid fluids 4 hrs prior to bed, avoid caffeine, avoid alcohol, avoid bladder irritants, smoking cessation, wt loss, kegels, keep voiding diary, support groups