Gynea Stuff

 Gynea Products Essay

9/18/2009

CASE DEMONSTRATION #1

URINARY INCONTINENCE

Clinical Clerkship Lecture Series

Mrs. Sixth is v. M.

44 year old woman GTPAL 44004 referred

by her family doctor with urinary

by her family doctor with urinary

incontinence.

What queries would help you in making

an analysis?

Urinary Incontinence - History

• Duration, intensity, onset

• Aggravating and relieving factors

• Organizations (eg. Coughing, laugh, sneeze,

(eg Cough laugh sneezing

related to exercise? )

• Urinary emergency, frequency

•? pads

• Interfering with life—normal actions?

Urinary Incontinence -- History

•

•

•

•

Obstetrical history

Monthly history

Perimenopause

Other medical illnesses—diabetes, neurological

disorders, preceding pelvic surgical treatment

• Friends and family medical history

• Vocational history--? heavy raising

• Medication list

Urinary Incontinence - Background

•

•

•

•

•

•

•

•

UTI, dysuria, hematuria

Nocturia

Enuresis

Little or significant urinary deficits

? continuous damage (WATT)

Weight changes

? prolapse symptoms

Waste incontinence, obstipation, diarrhea

Case #1 – Actual Background

• Mrs. V. Meters.

44 year old female GTPAL 44004 with 6 season history of

modern urinary loss with cough, laugh, sneezing and

exercise. Now requirements pads. Interfering with life. Normal

lif

urinary rate of recurrence. Loss of tiny volumes only. No new

urinary tract infections. Huge babies shipped vaginally,

1st required forceps and had associated tears. USER INTERFACE

worsened following last delivery. Has a feeling of pelvic

pressure. Nonetheless menstruating on a regular basis. No associated

bowel symptoms or excess weight changes. Considering your

advice—has heard about " pelvic exercises”.

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9/18/2009

Urtinary Incontinence – Physical

Examination

What aspects of the physical exam

are important to establishing prognosis in

are crucial to building a diagnosis in

this affected person?

Urinary Incontinence – Physical

Evaluation

• Vitals

• Standard physical test

and nerve exam decrease

• Back and neurological examination – reduced

extremities

• Detailed pelvic exam

• Cough tests –lying, position

• " Marshall-Bonney test” – urethral

hypermobility

Case #1 – Actual Physical

Studies

Urinary Incontinence -- Diagnosis

• Mrs. Versus. M.

-- normal fondamental and basic physical examination

- confident cough screening

cough screening

- hypermobile anterior genital wall

-- MB test out corrects reduction

- well estrogenized

-- anteverted, mobile uterus, zero masses

What is the " provisional” diagnosis through this

is your provisional medical diagnosis in this

sufferer, based upon her history and physical

examination?

Provisional Diagnosis

Urinary Incontinence Investigations

" Genuine tension urinary incontinence”

Differential Analysis??

What investigations would you buy or

investigations would you purchase or

consider to establish an analysis in this

individual?

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9/18/2009

Urinary Incontinence Brought on

Treatment Options

• Minimum:

-- urine lifestyle, R& Meters

- post-void residual

• Comprehensive—confirmatory:

-- bloodwork (CBC, BUN, Cr, TSH,? FSH)

- cystometrogram

-? Multichannel urodynamics

-? cystoscopy

What advice do you give this patient with regards to

her new diagnosis?

(Consider the very likely etiology, expected clinical

training course and treatment choices for this disorder. )

Urinary Incontinence –

Treatment Advice (Case #1)

Kegels Exercises!!

Physical exercises!!

Urinary Incontinence –

Treatment Options (Case #1)

•

•

•

•

•

•

Kegels, drill, timed toileting

Caffeine restriction

Careful fluid intake

fluid consumption

Medications—alpha-adrenergic busters

? pessaries

Surgical procedure

3

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