Term
| The storage phase of micturition is under ______ control. Which nn are involved? |
|
Definition
-sympathetic
-hypogastric stim detrusor rc & allows filling (relaxes bladder)
-pudendal nerve controls EUS voluntarily |
|
|
Term
| The voiding phase of micturition is under _____ control. Which nn are involved? |
|
Definition
-parasympathetic/cholinergic
-pelvic n stims |
|
|
Term
| What is urinary incontinence? |
|
Definition
| -loss of voluntary control of urination resulting in leakage of urine |
|
|
Term
| What are the 2 major causes of urinary incontinence? |
|
Definition
-intravesicular P > urethral P (dec detrusor complicance or poor urethral P)
-anatomic abnormalities which bypass the normal continence mechanisms |
|
|
Term
| What are some examples of neurogenic causes of incontinence? |
|
Definition
-sacral fx
-pelvic n or pelvic plexus trauma
-lumbosacral dz: IVDD< lymbosacral stenosis, neoplasia
-sacral malformations (Manx)
-FeLV
-generalized motor neuron dz
-dysautonomia |
|
|
Term
| What are the major non-neurogenic causes of incontinence? |
|
Definition
-USMI
-detrusor instability
-ectopic ureter |
|
|
Term
| What are the major differentials based on a large bladder w/ incontinence? |
|
Definition
-overflow incontinence
-lower motor neuron bladder = detrusor atony
-upper motor neuron bladder = automatic bladder |
|
|
Term
| What are the major differentials based on a small bladder w/ incontinence? |
|
Definition
-urethral sphincter mechanism incontinence (USMI)
-detrusor hyperspasticity
-ectopic ureter(s) |
|
|
Term
| What is the most common non-neurogenic cause of incontinence? |
|
Definition
|
|
Term
| What is the typical signalment for USMI? |
|
Definition
| -spayed/neutered medium to large breed dogs |
|
|
Term
| What are some of the contributing components of USMI? |
|
Definition
-dec estrogen affecting collagenous structures = dec intrinsic tone
-pelvic bladder
-obesity
-vaginal structure abnormalitis
-breeds: Standard Poodles, Labs, GSD
-hormonal alterations: DM, Cushings, DI |
|
|
Term
| What CS is USMI most commonly assoc w/? |
|
Definition
|
|
Term
|
Definition
| -positive response to therapy |
|
|
Term
| What are the two major components of USMI therapy? |
|
Definition
-sympathomimetic agents: PPA
-estrogen cpds: Incurin or DES |
|
|
Term
| What are the indications, AE, & contraindicatins of PPA (sympathomimetic) for treating USMI? |
|
Definition
-indications: male, cat, poor response to E2
-AE: hyperactivity, hypertension, anxiety, tachycardia, anorexia wt loss
-CI: hypertension & anxiety disorders |
|
|
Term
| What are the indications, AE, & CI of estrogens for treating USMI? |
|
Definition
-female dogs
-AE: behavioral change, marrow toxicity
-CI: male, intact females, cats |
|
|
Term
| Do we use intraurethral bulking agents for USMI? |
|
Definition
| -no b/c they all ave problems |
|
|
Term
| What is a hydraulic occluder and how does it treat USMI? |
|
Definition
-artificial urethral sphincter
-acts as a fake sphincter |
|
|
Term
| What is detrusor instability? |
|
Definition
-aka urge incontinence
-failure of bladder to stay relaxed during storage phase |
|
|
Term
| How do we treat detrusor isntability? |
|
Definition
-antimuscarinic agents: oxybutynin, propantheline
-tricyclic antidepressants: imipramine |
|
|
Term
| What is an ectopic ureter? |
|
Definition
| -ureter tunnels to a point distal to the trigone |
|
|
Term
| How do we treat an ectopic ureter? |
|
Definition
| -sx: nephrectomy & ureterectomy OR ureteral reimplantation |
|
|
Term
| HOw do we treat a neurogenic bladder? |
|
Definition
-empty bladder a6-8h
-monitor UA for signs of UTI
-culture if infection develops
-nursing care |
|
|
Term
| What causes detrusor atony? |
|
Definition
| -develops secondary to chronic or severe distention of bladder |
|
|
Term
| How do we treat detrusor atony? |
|
Definition
-indwelling urinary catheter
-parasympathomimetic = Bethanechol |
|
|
Term
| How do we treat sphincter hypertonus? |
|
Definition
-smooth m relaxants of IUS: Prazosin, phenoxybenzamine
-skeletal m relaxants = EUS: Diazepam |
|
|
Term
| What is reflex dyssynergia? Who is most commonly affected? |
|
Definition
-asynchrony b/n the detrusor m contraction & urethral sphincter relaxation
-males >> females |
|
|
Term
| What are he CS of reflex dyssynergia? |
|
Definition
-patient presents w/ pulsatile urine stream, stranguria, dysuria
-patient may strain to urinate |
|
|
Term
| How do we differentiate b/n a stone & reflex dyssynergia? |
|
Definition
-U-cath can be passed easily
-positive contract urethrogram is normal |
|
|
Term
| How do we treat reflex dyssynergia? |
|
Definition
-alpha-blockers & skeletal m relaxants
-may need bethanechol if urine stream is still weak |
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