on 16-Apr-2016 (Sat)

Tags

#exam #nephrology

Question

What is a renal cause of AKI?

Answer

inj d/t dysfn of renal parenchyma.

look for:
-systemic ft's (ds could also be affecting kidneys)
-HTN (NB: hypo for pre-renal)
-mild to mod ECF volume overload
-anemia/thrombocytopenia
-***abn urine sediment (RBC, WBC, protein, abn casts)***

Tags

#exam #nephrology

Question

What are 2 methods of urine evaluation?

Answer

1) dip stick → **alb, Hg, WBC**, others (glu, pH, urobilinogen, specific gravity)
2) microscopy → cells, crystals, casts

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#exam #nephrology

Question

What are 3 types of renal AKI causes?

Answer

1) tubulo-interstitial → acute tubular necrosis (atn), allergic/acute interstitial nephritis (ain), tubular obstruction
2) glomerular → prolif ds, non-prolif ds (rarely causes aki)
3) vascular → arteries (renal a stenosis, vasculitis), arterioles (atheroembolic ds, vasculitis), capillaries (thrombotic microangiopathies, vasculitis), veins/venules (thrombosis)

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#exam #nephrology

Question

What is ATN (acute tubular necrosis)?

Answer

• 2nd most common cause of AKI
• d/t ischemia/toxins
• look for signs of ↓ volume (pre-renal hypotension can cause ATN)
• **hemegranular casts** = dx

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#exam #nephrology

Question

What is allergic/acute interstitial nephritis (ain)?

Answer

interstitial inflm d/t:

• usually allergic rxn to drugs (abx, NSAIDS, PPIs, etc)
  • usually present 7-10d post-exposure
  • urine → RBC, WBC, protein, **WBC casts**
• autoimmune ds
• inf's

Tags

#exam #nephrology

Question

What is prolif glomerulonephritis?

Answer

• too many cells in glomerulus so can't filter → AKI
• present w/:
  • rapid ↓ in GFR
  • ​HTN, anemia
  • ↑ inflm markers
  • other systemic ft's (if 2ndary)
  • ECF volume full/mildy overloaded
• urine → **RBC casts** (nephrologic emerg)

Tags

#exam #nephrology

Question

CKD and Indications for dialysis

Answer

•**Persistent metabolic disturbances refractory to medical therapy
– Hyperkalemia
– Metabolic acidosis
• Fluid overload refractory to diuretics
• Progressive uremia
– Encephalopathy
– Persistent nausea and vomiting
– Evidence of malnutrition
• Pericarditis**

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#exam #nephrology

Question

Sodium [...] determines [...]
Sodium concentration determines intracellular fluid (ICF) volume
Sodium concentration does NOT predict ECF volume status

Answer

**Sodium content determines extracellular fluid (ECF) volume status
Sodium concentration determines intracellular fluid (ICF) volume
Sodium concentration does NOT predict ECF volume status**

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#exam #nephrology

Question

Sodium content determines extracellular fluid (ECF) volume status
Sodium [...] determines [...]
Sodium concentration does NOT predict ECF volume status

Answer

**Sodium content determines extracellular fluid (ECF) volume status
Sodium concentration determines intracellular fluid (ICF) volume
Sodium concentration does NOT predict ECF volume status**

Tags

#exam #nephrology

Question

Sodium content determines extracellular fluid (ECF) volume status
Sodium concentration determines intracellular fluid (ICF) volume
Sodium [...] does NOT predict [...]

Answer

**Sodium content determines extracellular fluid (ECF) volume status
Sodium concentration determines intracellular fluid (ICF) volume
Sodium concentration does NOT predict ECF volume status**

Tags

#exam #nephrology

Question

Na balance:

input (determined by diet)

output
--small extrarenal loss
--Renal excretion controlled by [...]
• Activation of RAAS results in [...]

Answer

**Renin‐Angiotensin‐Aldosterone System (RAAS)

sodium retention**

Tags

#exam #nephrology

Question

H2O balance:

input (thirst → intake)

output
--extrarenal loss small
--Renal excretion controlled by [...]
• Release of ADH results in [...]

Answer

**antidiuretic hormone (ADH)
water retention**

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#exam #nephrology

Question

Hyponatremia ALWAYS a result of [...]

Answer

**Hyponatremia ALWAYS a result of relative water retention**

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#exam #nephrology

Question

Why is there H2O retention in hyponatremia?

Answer

**ADH** (main cause)
no kidney fn/GFR
no osmoles to excrete in urine

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#exam #nephrology

Question

Treatment of Life‐Threatening Hyperkalemia

Answer

**Four principles of management:
(1) Stabilize myocardium
--Give Calcium Gluconate IV

(2) Shift potassium into cells
--IV insulin
--IV or inhaled beta2‐agonist

(3) Potassium excretion
--90% renal - ↑ ECFV w/ IV saline to promote flow to CCD, then give IV furosemide
--10% GI - promote diarrhea (cation exchange resins) - avoid post-op use

(4) Hemodialysis - if above insufficient**

Tags

#exam #nephrology

Question

pH = [...]
plasma CO2 = 40mmHg
plasma HCO3 = 24mmol/L
plasma anion gap = 12mEq/L

Answer

pH = 7.40
plasma CO2 = 40mmHg
plasma HCO3 = 24mmol/L
plasma anion gap = 12mEq/L

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#exam #nephrology

Question

pH = 7.40
plasma CO2 = [...]
plasma HCO3 = 24mmol/L
plasma anion gap = 12mEq/L

Answer

pH = 7.40
plasma CO2 = 40mmHg
plasma HCO3 = 24mmol/L
plasma anion gap = 12mEq/L

Tags

#exam #nephrology

Question

pH = 7.40
plasma CO2 = 40mmHg
plasma HCO3 = [...]
plasma anion gap = 12mEq/L

Answer

pH = 7.40
plasma CO2 = 40mmHg
plasma HCO3 = 24mmol/L
plasma anion gap = 12mEq/L

Tags

#exam #nephrology

Question

pH = 7.40
plasma CO2 = 40mmHg
plasma HCO3 = 24mmol/L
plasma anion gap = [...]

Answer

pH = 7.40
plasma CO2 = 40mmHg
plasma HCO3 = 24mmol/L
plasma anion gap = 12mEq/L

Tags

#exam #nephrology

Question

Four Primary Acid‐Base Disorders:

Metabolic acidosis: pH [...] and [...]
Metabolic alkalosis: pH [...] and [...]
Respiratory acidosis: pH < 7.4 and ↑PCO2
Respiratory alkalosis: pH > 7.4 and ↓PCO2

Answer

Four Primary Acid‐Base Disorders:

Metabolic acidosis: pH < 7.4 and ↓[HCO3‐]
Metabolic alkalosis: pH > 7.4 and ↑[HCO3‐]
Respiratory acidosis: pH < 7.4 and ↑PCO2
Respiratory alkalosis: pH > 7.4 and ↓PCO2

Tags

#exam #nephrology

Question

Four Primary Acid‐Base Disorders:

Metabolic acidosis: pH < 7.4 and ↓[HCO3‐]
Metabolic alkalosis: pH > 7.4 and ↑[HCO3‐]
Respiratory acidosis: pH [...] and [...]
Respiratory alkalosis: pH [...] and [...]

Answer

Four Primary Acid‐Base Disorders:

Metabolic acidosis: pH < 7.4 and ↓[HCO3‐]
Metabolic alkalosis: pH > 7.4 and ↑[HCO3‐]
Respiratory acidosis: pH < 7.4 and ↑PCO2
Respiratory alkalosis: pH > 7.4 and ↓PCO2

Tags

#exam #nephrology

Question

Five Steps to Solving Acid Base Problems

Answer

(1) Look at the pH: Acidemia vs Alkalemia

(2) What is the primary problem?:
Compare HCO3 vs pCO2

(3) Is there adequate compensation?
met acid = 1:1 (pCO2)
met alk = 1:0.7 (pCO2)
R acid A = 1:10 (pCO2)
R acid C = 3:10 (pCO2)
R alk A = 2:10 (pCO2)
R alk C = 5:10 (pCO2)

(4) a) What is the Anion Gap?
AG = Na – (Cl + HCO3)
--Normal is 12 +/‐ 2 mmol/L

b) Is there an Osmolar Gap?
Osmolar gap = Osm(meas) – Osm(calc)
Osm(calc) = 2Na + Urea + Glucose
--Normal is upto 10 mosm/kg

(5) Is there another metabolic disorder?
Does the Δ AG = Δ HCO3?
Δ AG = Δ HCO3 (only AGMA)
Δ AG < Δ HCO3 (AGMA + met alk)
Δ AG > Δ HCO3 (AGMA + NAGMA)

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#exam #nephrology

Question

met acid causes w/ ↑ AG

Answer

**• Lactic acidosis
• Ketoacidosis
--diabetic
--alcoholic
--starvation
• Toxins
– Methanol
– Ethylene glycol
– Salicylates
• Severe chronic kidney disease**

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#exam #nephrology

Question

met acid causes w/ normal AG

Answer

**NaHCO3 Loss
– GI (Diarrhea)
– Renal (Low urine NH4+, Seen in chronic kidney disease or renal tubular acidosis)**

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#america #benefit #borat #cultural #for #glorious #kazakhstan #learnings #make #nation #of

Question

"What type of dog is this?"

Answer

"You're welcome."

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#exam #urology

Question

What are the complications of prostatectomy?

Answer

peri-op: anesthetic risks, bleed/transf, UTI, wound inf, MI, DVT/PE, bowel/rectal/bladder/ureteric injury, etc

post-op: erectile dysfn, stress urinary incontinence, urethral strictures, LUTS, PCa recurrence

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#exam #urology

Question

How do you prevent Ca stones?

Answer

Diet
--**↑ fluid
--↓ animal protein, Na, oxalate, EtOH
--do NOT ↓ Ca intake (Ca binds oxalate)**

meds
--hydrochlorothiazide (hypercalciuria) - promote Ca reabsorption
--K citrate (↑ pH & citrate lvl in urine)

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#exam #urology

Question

What causes struvite stones?

Answer

inf w/ urea-splitting bugs (proteus, klebsiella, pseudomonas) → alkaline urine (pH>7.5)
--**NOT ECOLI**

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#exam #urology

Question

What causes cystine stones?

Answer

d/t aa transport problem (autosomal recessive defect)
--↓ reabsorption of COLA (cystine, ornithine, lysine, arginine)

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#exam #urology

Question

DDx of renal colic

Answer

**• Acute ureteric obstruction (other causes)
– UPJ obstruction
– Sloughed papilla
– Clot colic from gross hematuria
• Pyelonephritis (fever, pyuria, flank pain) without a stone
• Acute abdominal crisis: appendicitis, diverticulitis, biliary colic, bowel obstruction, pancreatitis
• Ruptured abdominal aortic aneurysm (AAA)
• Gynecological: ectopic pregnancy, torsion / rupture of ovarian cyst
• Radiculitis (L1) – herpes zoster, nerve root compression**

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#exam #urology

Question

Indications for admission or urgent intervention in kidney stone ds

Answer

**– Pain not controlled with oral analgesics
– Fever and urinary tract infection with obstructing stone
– Refractory vomiting
– Solitary kidney with obstruction OR bilateral obstructing stones → RENAL FAILURE
– Severe hematuria**

Tags

#urology

Question

What evaluations do you do for ED?

Answer

Hx & p/e

investigations:
--uncontrolled DM
--hypogonadism
--RF for CV ds (lipid profile)

Tags

#urology

Question

What are the rx for ED?

Answer

counselling, oral meds, injections, intraurethral, other devices, penile implant (3rd line)

1st line: lifestyle/drug therapy moderations, psychosocial counselling, androgen replacement therapy (younger men), oral (PDE5 inhibs - tadalafil, sildenafil, vardenafil)

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#urology

Question

benign renal lesions

Answer

renal cyst
angiomyolipoma
oncocytoma

Tags

#urology

Question

What is a renal cyst?

Answer

--fluid-filled sac in the kidney parenchyma
--most common benign renal mass
--uses Bosniak classification (likelihood of malig)
--anechoic on u/s with post-acoustic enhancement

Tags

#urology

Question

what is an angiomyolipoma?

Answer

--solid lesion
--the presence of fat is pathognemonic for AML
--usually asx
--hyperechoic on u/s
--no calcifications
--no lymphadenopathy
--rx if risk of bleeding (≥4cm) or symptomatic or pregnant

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#urology

Question

What is the rx for angiomyolipoma?

Answer

--angioembolization (#1)
--partial/radical nephrectomy depending on size

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#urology

Question

what is an oncocytoma?

Answer

benign renal lesion that's hard to tell apart from carcinoma
--need pathology for dx

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#urology

Question

What is renal cell carcinoma?

Answer

--85% of renal cancers
--peak @ 60-70y/o, males

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#urology

Question

What are risk factors of renal cell carcinoma?

Answer

smoking, exposures, ESRD, HTN, obesity, rad rx

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#urology

Question

What are mets sites of renal cell carcinoma?

Answer

LN, lung, liver, bone, adrenal gland, brain, the other kidney

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#urology

Question

What are s&s of renal cell carcinoma?

Answer

--usually asx unless adv/mets
--paraneoplastic syndrome (10-20%) - polycythemia, anemia, HTN, fever, hypercalcemia, neuromyopathy, non-mets hepatic dysfn, amyloidosis, cachexia

Tags

#urology

Question

What are the histology cell types of renal cell carcinoma?

Answer

--clear cell (70%)
--papillary (10%)
--chromophobe (5%) - less aggressive, less mets
--collecting duct (<1%) - very aggressive, more mets
--other (<1%)

Tags

#urology

Question

how do you dx renal cell carcinoma?

Answer

imaging
--u/s + CT (pre & post contrast) - look for enhancement, calcifications, staging
--usually solid & hypoechoic on u/s

MRI - if young/pregnant/can't CT
--look for enhancement
--can differentiate b/w clear cell & papillary

percutaneous bx
--if unsure of dx, if may alter mgmt, if good IR & GU pathologist

Tags

#urology

Question

How can you rx renal cell carcinoma?

Answer

surgery (main)
--radical nx (gold standard for oncologic control)
--partial nx (pref if feasible)
--thermal ablation (newer)

tumours are chemo-resistant
rad not as good

active surveillance

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#urology

Question

[...] is the most common type of bladder cancer

Answer

Urothelial carcinoma
NB: >90%; cancer of lining of bladder

Tags

#urology

Question

What are the risk factors for bladder cancer?

Answer

#1 = smoking
--occupational carcinogens
--arsenic exposure
--aristolochic acid (chinese herb)
--chronic cystitis
--genetics
--Fhx
--schistosomiasis UTI
--iatrogenic (rad, cyclophosphamide - chemo)

Tags

#urology

Question

What are s&s of bladder cancer?

Answer

--hematuria (most common) - if present, urothelial carcinoma unless proven otherwise
--pain
--LUTS
--constitutional sx

Tags

#urology

Question

how do you dx bladder cancer?

Answer

--urine tests (cytology) - 98% SP, 34% SN - operator-dependent - detects shed cells in urine
--imaging (CT abdo/pelvis = best; or abdo u/s)
--cystoscopy
--bx - transurethral resection of bladder tumour (TURBT) for pathology

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#exam #urology

Question

[...] is the biggest factor in bladder cancer mgmt

Answer

**Invasion into the bladder wall msc**

NB:
--non-msc invasive UC (most common ~70%) - lower mets, higher recurrence
--msc invasive UC (~30%) - higher mets, death

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#urology

Question

What is the mgmt for non-msc invasive UC?

Answer

--TURBT = dx & rx
--single dose IV chemo post-op (kills remaining cells post-TURBT)
--surveillance cystoscopy
--surveillance of upper tracts (ureters & kidney) - ~5% risk of upper tract cancer
--intravesical rx for induction & maintenance (prevent progression)​

• immunotherapy (BCG)
• chemo (MMC) - decreased effectiveness

Tags

#urology

Question

What is the mgmt for msc-invasive UC?

Answer

--TURBT is mainly for dx
--major extirpative therapy + reconstruction (ileal conduit, neobladder) - removal of bladder
--adjunct - chemo (neo = increased survival; post-surg = less evidence)
--bladder-sparing options - aggressive TURBT

gold standard = radical cystectomy + pelvic LN dissection + neoadjuvant chemo

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#urology

Question

What structures form from the wolffian duct?

Answer

Epididymis, vas deferens, seminal vesicles, ejaculatory duct

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#urology

Question

What structures form from the mullerian duct?

Answer

Uterus, fallopian tubes, upper part of the vagina

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#urology

Question

Hypothalamus ( [...] ) -> pituitary gland ( [...] ) -> testis -> [...] & [...] cells

sertoli cells ( [...] ) -> hypothal
leydig cells ( [...] ) -> hypothal
-neg feedback loops

Answer

Hypothalamus (GnRH) -> pituitary gland (LH/FSH) -> testis -> sertoli & leydig cells

sertoli cells (inhibin) -> hypothal
leydig cells (T&E) -> hypothal
​-neg feedback loops

Tags

#urology

Question

What forms the testis blood barrier?

Answer

sertoli cells
--forms immunocompetent area for sperm to survive
--haploid sperm are foreign to the body

Tags

#urology

Question

What matures & stores sperm?

Answer

epididymis
--it takes 3mo for sperm to mature and develop to be ejaculated
--sperm get transported to vas
--sperm gain motility in the tail (?) of epididymis
--smoking interrupts (something) at head of epididymis
--infections & toxins interrupt the body
--something about mt?

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#urology

Question

What questions do you ask on duration of infertility?

Answer

--primary (no pregnancy) vs secondary (miscarriage/birth)
--prev rx
--female factor (anovulation, tubal obstruction)

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#urology

Question

Inferitility hx: childhood & development

Answer

cryptochidism
pubertal development

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#urology

Question

infertility hx: pmh

Answer

systemic illness

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#urology

Question

infertility hx: surgical hx

Answer

abdo, pelvic, scrotal surgery

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#urology

Question

infertility hx: infections

Answer

STD's, prostatitis, orchitis (post-pubertal mumps)

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#urology

Question

infertility hx: environmental gonadotoxins

Answer

smoking, recreational drugs (marijuana), anabolic steroids, pesticides (DBCP), workplace chemicals (solvents)

Tags

#urology

Question

infertility hx: meds

Answer

hormonal (pre-testicular)
--androgens, anti-androgens, estrogens
gonadotoxic (testicular)
--chemo/alkylating agents
--abx, sulfasalazine
sperm-toxic (post-testicular)
--CCB's

Tags

#urology

Question

infertility hx: sexual hx

Answer

1. Erectile Function/Libido
2. Lubricants
3. Frequency of intercourse
4. Timing of intercourse

Tags

#urology

Question

infertility p/e

Answer

--general apperance (kleinfelter's)
--CNS: quadraplegic, etc
--gynecomastia
--abdo mass/scar

Genital exam
--penile anatomy (position of meatus)
--testis size (4x2cm), consistency, location
--presence of vas deferens
--epididymal congestion
--varicocele (grade 1-3)

Question

What should you take note about testicular varicoceles?

Answer

--one of main causes of infertility
--most occurs on Lt or both
--if pt comes in w/ new Rt mass, think retroperitoneal mass or other (not varicocele)

--gr 1 = not visible, can see reflux of bloodflow w/ valsalva
--gr 2 = in between
--gr 3 = visible

Tags

#urology

Question

infertility evaluations

Answer

--semen analysis x2
--hormonal profile

Tags

#urology

Question

azoospermia ddx

Answer

pre-testicular
--hypothalamus, pituitary

testicular
--testicular failure, non-obstructive azoospermia

post-testicular
--obstruction or absence of Wolffian structures

Tags

#urology

Question

What are FSH, LH, and T values for pre-testicular, testicular, and post-testicular azoospermia?

Answer

	FSH	LH	T
pre-testicular	low	low	low norm
testicular	high	high/norm	norm
post-testicular	norm	norm	norm

Tags

#urology

Question

infertility genetic screening

Answer

karyotype
--klinefelters (XXY)
--robersonian translocation
--XX male

Y-chromosome microdeletion

Tags

#urology

Question

what is klinefelter syndrome?

Answer

--47, XXY + variants
--sterile
--gynecomastia
--eunuchoid (indeterminate sex ft's)
--delayed puberty
--high FSH, high LH, low T

Tags

#urology

Question

Klinefelter's infertility rx

Answer

microdissection testicular sperm extraction (micro-TESE)

in vitro fertilization (IVF)

intracytoplasmic sperm injection (ICSI)

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#exam #urology

Question

when do you suspect undescended testis?

Answer

prematurity
scrotal asymmetry
testicle not in scrotum @ birth

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#exam #urology

Question

there is no value in u/s for [...]
(pediatric urology)

Answer

non-palpable testis

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#exam #urology

Question

What should you think if you see a "boy" with bilat impalpable gonads?

Answer

--always think disorder of sexual differentiation (congenital adrenal hyperplasia)
--these pt are salt-wasters (can die)
--actually female

Tags

#exam #urology

Question

pediatric acute scrotum
-most important dx
-ddx

Answer

acute scrotum = surgical emergency

most imp dx
--testicular torsion

• emergent scrotal exploration
• time is key!
• testicular atrophy rates increase sig after 6-8h of ischemia

ddx
--epididymis (positive/neg urinalysis)
--testicular torsion (acute onset, cremaster reflex neg)

Tags

#exam #urology

Question

How can you prevent paraphimosis?

Answer

paraphimosis = foreskin trapped behind glans of penis

--remember to reduce the foreskin after inserting a foley catheter

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#exam #urology

Question

[...] grade antenatal hydronephrosis = worse

Answer

higher

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#exam #urology

Question

what is posterior urethral valves?

Who's at risk? When do you suspect it?

Answer

--only affects males
--most common congenital bladder obstruction
--suspect if bilat hydronephrosis
--look for the key hole sign

Tags

#exam #urology

Question

What is the mgmt for post urethral valves?

Answer

neonate: if suspected, place catheter after birth to bypass obstruction

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#exam #urology

Question

What happens with isolated primary nocturnal enuresis?

Answer

spontaneous resolution (7% @ 7y/o to <1% in adults)

invasive investigations not indicated if normal p/e

Tags

#urology

Question

What are the LUT innervations?

Answer

--pons (central control centre)
--sympa (T10-12) @ T6 vertebral level

• storage, innervates β3 receptors
• α receptors

--para (S2-4) - muscarinic receptor for voiding
--somatics (S2-4) - skeletal muscles (S234 keeps the urine off the floor)

Tags

#urology

Question

What are causes for failure to store urine?

Answer

--overactive bladder -> urgency incontinence
--incompetent outlet -> stress incontinence

Tags

#urology

Question

What are reasons for failure to empty urine?

Answer

--hypoactive/tonic bladder
--obstructive outlet (less likely in females)
(both lead to overflow incontinence)

Tags

#urology

Question

mixed incontinence = [...] + [...]

Answer

stress
urgency

Tags

#urology

Question

what causes continuous/total incontinence?

Answer

--fistula (vesicovaginal), ectopic ureter, etc
--no sense of urgency

Tags

#urology

Question

What is the mgmt for urinary incontinence?

Answer

--artificial urinary sphincter
--male advance sling system

Tags

#urology

Question

What is OAB (over active bladder)?

Answer

--sense of urgency
--freq (>8/day)
--nocturia
--wet vs dry (wet - incontinence, more in females, UMN neuropathy, d/t lesions above parasympathetics)

Tags

#urology

Question

What is stress incontinence?

Answer

--most common type
--almost only in females
--males if prostatectomy injury
--increased pressure on bladder
--risk factors: parity, obesity, COPD, etc

Tags

#urology

Question

With a [...] you can have initial retension of urine from detrusor areflexia due to spinal shock

Answer

With a cerebrovascular accident (CVA) you can have initial retension of urine from detrusor areflexia due to spinal shock

NB: CVA = stroke

Tags

#urology

Question

With a cerebrovascular accident (CVA) you can have [...] of urine from [...] due to spinal shock

Answer

With a cerebrovascular accident (CVA) you can have initial retension of urine from detrusor areflexia due to spinal shock

Tags

#urology

Question

With a cerebrovascular accident (CVA) you can have initial retension of urine from detrusor areflexia due to [...]

Answer

With a cerebrovascular accident (CVA) you can have initial retension of urine from detrusor areflexia due to spinal shock

Tags

#urology

Question

What bladder sx do you see with MS and why?

Answer

bladder sx - detrusor over activity urgency incontinence most common

due to uncoordinated sphincter & bladder activity
--sphincter shut while bladder contracting -> backflow of urine

Tags

#urology

Question

What is the mgmt of urgency incontinence?

Answer

--behavioural therapy - education (timed voiding, pelvic msc training, etc)
--med

• antimuscarinics to prevent contractions
• β3 agonist for relaxation

--if refractory, surgery

• botox - prevents exocytosis + release of neurotransmitters (for neurogenic detrusor overactivity); can have increased retention which is problem for older pt's
• permanent implant - stimulates & modulates nn
• bladder augmentation (reconstruction) - increase capacity of bladder + decrease pressure of bladder (use ileum)

Tags

#urology

Question

What is the mgmt for stress incontinence?

Answer

--no medical rx
--mian is surgery

• pubovaginal sling
• burch procedure (bladder neck suspension)
• TVT (synthetic sling)
• periurethral injection (not done much in Canada)

--behavioural & physio