Motor Urge (Hypertonic) Incontinence
• Etiology. Involuntary rises in bladder pressure occur from idiopathic detrusor con-tractions that cannot be voluntarily suppressed.
• History. Loss of urine occurs in large amounts often without warning. This can takeplace both day and night. The most common symptom is urgency.
• Examination. Pelvic examination shows normal anatomy. Neurologic examination isnormal.
• Investigative studies. Urinalysis and culture are normal. Cystometric studies shownormal residual volume, but involuntary detrusor contractions are present even with small volumes of urine in the bladder.
• Management. Anticholinergic medications (e.g., oxybutynin [Ditropan]); nonsteroi-dal antiinflammatory drugs (NSAIDs) to inhibit detrusor contractions; tricyclic anti-depressants; calcium-channel blockers.
GYN Triad
Hypertonic Bladder
• Involuntary loss of urine
• Cannot suppress urge to void
• Urine loss day and night
159
| S2 OB-GYN.indb 159 | 7/8/13 6:35 PM | |||
GI
USMLE Step 2 l Gynecology
| GYN Triad | Overflow (Hypotonic) Incontinence | ||
| • Etiology. Rises in bladder pressure occur gradually from an overdistended, hypotonic | |||
| Hypotonic bladder | |||
| bladder. When the bladder pressure exceeds the urethral pressure, involuntary urine | |||
| • Involuntary loss of urine | |||
| loss occurs but only until the bladder pressure equals urethral pressure. The bladder | |||
| • Detrusor muscle not | never empties. Then the process begins all over. This may be caused by denervated | ||
| contracted | bladder (e.g., diabetic neuropathy, multiple sclerosis) or systemic medications (e.g., | ||
| ganglionic blockers, anticholinergics). | |||
| • Urine loss day and night | |||
| • History. Loss of urine occurs intermittently in small amounts. This can take place | |||
| both day and night. The patient may complain of pelvic fullness. | |||
| • Examination. Pelvic examination may show normal anatomy; however, the neurologic | |||
| examination will show decreased pudendal nerve sensation. | |||
| • Investigative studies. Urinalysis and culture are usually normal, but may show an | |||
| infection. Cystometric studies show markedly increased residual volume, but invol- | |||
| untary detrusor contractions do not occur. | |||
|
|
|
GYN Triad
Bypass Incontinence
• Involuntary loss of urine
• History: radical pelvic surgery or radiation
• Urine loss day and night continuously
• Management. Intermittent self-catheterization may be necessary. Discontinue theoffending systemic medications. Cholinergic medications to stimulate bladder con-tractions and a-adrenergic blocker to relax the bladder neck.
Fistula
• Etiology. The normal urethral-bladder mechanism is intact, but is bypassed by urineleaking out through a fistula from the urinary tract.
• History. The patient usually has a history of radical pelvic surgery or pelvic radiationtherapy. Loss of urine occurs continually in small amounts. This can take place both day and night.
• Examination. Pelvic examination may show normal anatomy and normal neurologicfindings.
• Investigative studies. Urinalysis and culture are normal. An intravenous pyelogram(IVP) will demonstrate dye leakage from a urinary tract fistula. With a urinary tract-vaginal fistula, intravenous indigo carmine dye will leak onto a vaginal tampon.
• Management. Surgical repair of the fistula.
Дата добавления: 2018-11-24; просмотров: 239; Мы поможем в написании вашей работы! |
Мы поможем в написании ваших работ!