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Duke PA Pelvic Floor Disease

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Question
Answer
As many as __% of women will have urinary incontinence at some point in their lifetime   45  
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Hypermobility, intrinsic sphincter deficiency   Stress incontinence  
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Detrusor overactivity, overactive bladder   Urge incontinence (hyper-irritable, unstable, detrusor contractions)  
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Urge incontinence, think __   Neurologic problem  
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Overflow incontinence, think __   Inability to void  
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Increased abdominal pressure, coughing or straining, not associated with urge   Stress incontinence  
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Often large volume, associated with strong desire to void, may be precipitated by sounds   Urge incontinence  
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Pinpoints the site of urinary incontinence by assessing the bladder, urethra and pelvic support   Urodynamic testing (considered gold standard)(although has poor neg predictive value)  
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__ has proven ineffective for the treatment of stress incontinence   Pharmacotherapy  
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Premise of the suburethral sling   Support the urethra and bladder neck with hammock that provides stabilization of urethra at rest and dynamic compression of urethra with increased intraabdominal pressure  
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Intrinsic Sphincter Deficiency, think:   stress incontinence  
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Contributors to intra-abdominal pressure (may lead to incontinence)   Childbirth, obesity, asthma, smoking, chronic heavy lifting  
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MOA of pelvic floor damage   Mx disruption; Peripheral nerve damage; Connective tissue damage (inc lacerations of perineal body)  
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the most commonly associated inciting factor for incontinence.   Childbirth  
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Causes of stress UI   Childbirth; PF mx weakness; decreased collagen synthesis; previous pelvic surgery (eg, hysterectomy); Smoking, chronic constipation; Aging, estrogen deficiency  
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Extraurethral incontinence:   fistulas  
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Goal of urodynamic testing   reproduce symptoms of leakage in order to direct therapy  
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Effective tx for SUI   Behavioral (mx exercises, biofeedback); Pessary; surg  
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Tx for urge incontinence   Behavioral Tx; Meds (Anticholinergics); Peripheral neuromodulation (inter-stim); Botox Injections  
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