when your patients gotta go!!!!!
DESCRIPTION
When Your Patients Gotta Go!!!!!. Raji Gill, D.O., M.Sc. Clinical Assistant Professor of Surgery Division of Urology Oklahoma State University. Incontinence. Types Overflow / retention Stress / overactive. History. Urgency, frequency, nocturia Incomplete bladder emptying - PowerPoint PPT PresentationTRANSCRIPT
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When Your Patients Gotta Go!!!!!
Raji Gill, D.O., M.Sc.Clinical Assistant Professor of Surgery
Division of UrologyOklahoma State University
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Incontinence
• Types• Overflow / retention• Stress / overactive
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History
• Urgency, frequency, nocturia• Incomplete bladder emptying• Leak when straining• Weak stream, post void dribbling
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Past Medical Conditions
• Multiple sclerosis, spinal cord injury
• Diabetes• Parkinsons Disease
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Medications
• Worsen overflow • Ephedrine (Rynatuss),
pseudoephidrine, imiprimine (Tofranil)Worsen stress• Clonidine (Catapress),
phenoxybenzamine
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Physical
• Check post void residual (PVR)• Normal less than 50cc• Abnormal more than 200cc
• Digital rectal exam• Larger prostate (more than • 40 gms)
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Treatment
• Overflow / retention• If PVR 50 – 200cc, timed voids, double
voids• If PVR > 200cc, straight cath or foley
• Stress / overactive• Do not hold urine
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Medical Therapy• Overflow
• Alpha blockers act on smooth muscle receptors in the prostate (Hytrin, Cardura, Flomax)
• 5 alpha reductase inhibitor lowers dihydrotestosterone levels (Proscar, Avodart)
• Stress / overactive• Anticholinergics for involuntary detrusor
contraction (Ditropan, Detrol)• Tricyclic anidepressants (Imipramine,
Tofranil)
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Surgical Therapy
• TURP, microwave therapy, thermotherapy for enlarged prostates
• Periurethral injections• Urethral suspensions• Sphincter prosthesis• Sacral nerve stimulation
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The End