Urinary incontinence simply means involuntary leaking of urine.
Incontinence can range from leaking just a few drops of urine to complete emptying of the bladder.
Social and hygienic problem.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. The normal function of the urinary bladder is
to store and expel urine in a coordinated,
controlled fashion.
This coordinated activity is regulated by the
central and peripheral nervous systems.
Neurogenic bladder is a term applied to a
malfunctioning urinary bladder due to
neurologic dysfunction or insult emanating
from internal or external trauma, disease, or
injury.
3. Normal voiding essentially is a spinal reflex
that is modulated by the central nervous
system (brain and spinal cord), which
coordinates the functions of the bladder and
urethra.
The bladder and urethra are innervated by
autonomic nervous system (ANS) and somatic
nervous system respectively.
4. The micturition control center is located in the
frontal lobe of the brain.
The primary activity of this area is to send
tonically inhibitory signals to the detrusor
muscle
The signal transmitted by the brain is routed
through 2 intermediate stops (the brainstem
and the sacral spinal cord) prior to reaching the
bladder.
5. The pontine micturition center (PMC) is a
major relay center between the brain and the
bladder.
The conscious sensations associated with
bladder activity are transmitted to the pons
from the cerebral cortex.
Stimulation of the PMC causes the urethral
sphincters to open while facilitating the
detrusor to contract and expel the urine
6. The PMC is affected by emotions.
The ability of the brain to control the PMC is
part of the social training that children
experience during growth and development
7. Is long communication pathway between the
brainstem and the sacral spinal cord
The sacral spinal cord is a specialized area of
the spinal cord known as the sacral reflex
center. It is responsible for bladder
contractions.
The sacral reflex center is the primitive voiding
center,controls urination reflex in infancy.
8.
9. Under normal conditions, the bladder and the
internal urethral sphincter primarily are under
sympathetic nervous system control.
The sympathetic nervous system causes
urinary accommodation.
The parasympathetic nervous system
facilitates of voluntary urination.
The somatic nervous system regulates the
actions of the muscles under voluntary
control. Activation of the pudendal nerve
causes urinary accommodation
12. Urgency: Loss of normal ability to postpone micturation
beyond time when desire is first precieved.
Incontinence: involuntary passage of urine.
Stress incontinence:leakage of urine due to coughing or
straining ofen due to pelvic floor muscle weakness.
Hesitancy: difficulty in initiating micturation.
Dribbling: incomplete urination iin a clean stop fashion.
Overflow incontinence:progressive bladder involment
with continuous or intermittent dribbling of urine.
13. 1.BRAIN LESION:
Lesions of the brain above the pons destroy the
master control center, causing a complete loss
of voiding control.
The voiding reflexes of the bladder—the
primitive voiding reflex—remain intact.
14. Affected individuals show signs of urge
incontinence, or spastic bladder.
Presents with FREQUENCY,URGENCY &
URGE INCONTINENCE.
This condition is termed as “detrusor
hyperreflexia or overactivity or uninhibited
bladder or automatic bladder.”
15. 2. Spinal cord lesion
Diseases or injuries of the spinal cord between
the pons and the sacral spinal cord also result
in spastic bladder or overactive bladder.
The voiding disorder is similar to that of the
brain lesion except that the external sphincter
may have paradoxical contractions as well.
16. Result in uninhibited bladder contraction
with uncoordinated sphincter activity.
Presents with FREQUENCY,URGENCY &
URGE INCONTINENCE and an overwhelming
desire to urinate but only a small amount of
urine may dribble out
Condition termed as “detrusor-sphincter
dyssynergia”
17. 3.Sacral cord injury:
1.Sensory neurogenic bladder is present, the
affected individual may not be able to sense
when the bladder is full.
2.Motor neurogenic bladder, the individual will
sense the bladder is full and the detrusor may
not contract.
18. Present with difficulty eliminating urine and
experience overflow incontinence; the
bladder gradually overdistends until the urine
spills out.
Condition termed as “detrusor areflexia”
21. SUPRASPINAL LESION PRESENTATION
Cerebrovascular accident Detrusor areflexia followed by
detrusor hyperreflexia
Brain tumor Detrusor hyperreflexia
Parkinson disease Detrusor hyperreflexia and urethral
sphincter bradykinesia
Shy-Drager syndrome Detrusor hyperreflexia with open
internal sphincter at rest
22. SPINAL LESION PRESENTATION
Spinal Shock Detrusor areflexia followed by
detrusor hyperreflexia
Spinal cord lesions (above or below
sixth thoracic vertebrae)
Detrusor-sphincter dyssynergia
Spinal cord lesions (at the sixth
thoracic vertebrae)
Detrusor-sphincter dyssynergia with
Autonomic dysreflexia
23. Peripheral Nerve Lesions PRESENTATION
Diabetic cystopathy Sensory neurogenic bladder followed
by Motor neurogenic bladder
Tabes dorsalis (neurosyphilis) Detrusor areflexia with normal
sphincteric function.
Herpes zoster Detrusor hyperreflexia followed by
Detrusor areflexia
24. Postvoid residual urine
The postvoid residual urine (PVR) measurement is a
part of basic evaluation for urinary incontinence. If
the PVR is high, the bladder may be contractile or
the bladder outlet may be obstructed.
Uroflow rate
Uroflow rate is a useful screening test used mainly
to evaluate bladder outlet obstruction.
Low uroflow rate may reflect urethral obstruction, a
weak detrusor, or a combination of both. This test
alone cannot distinguish an obstruction from a
contractile detrusor.
25. Voiding cystometrogram (pressure-flow study)
Pressure-flow study simultaneously records the voiding
detrusor pressure and the rate of urinary flow. This is the
only test able to assess bladder contractility and the
extent of a bladder outlet obstruction.
Cystogram
A static cystogram helps to confirm the presence of
stress incontinence, the degree of urethral motion, and
the presence of a cystocele.
A voiding cystogram can assess bladder neck and
urethral function (internal and external sphincter)
during filling and voiding phases
26. Electromyography
Electromyography (EMG) helps to ascertain the presence
of coordinated or uncoordinated voiding.
Cystoscopy
The role of cystoscopy in the evaluation of neurogenic
bladder is to allow discovery of bladder lesions (eg, bladder
cancer, bladder stone) that would remain undiagnosed by
urodynamics alone.
27. Treatment of urinary incontinence varies by type, as
follows:
Stress incontinence may be treated with surgical
and nonsurgical means
Urge incontinence may be treated with behavioral
modification or with bladder-relaxing agents
Mixed incontinence may require medications as
well as surgery
Overflow incontinence may be treated with some
type of catheter regimen
28. Certain fluids can irritate the bladder:
Carbonated drinks
Citrus juices
Caffeinated drinks, e.g. soda, tea, coffee
Alcoholic beverages
29. The benefits of adequate fluid intake include prevention of dehydration,
constipation, urinary tract infection.
Trying to prevent incontinence by restricting fluids excessively may lead
to bladder irritation and actually worsen urge incontinence, and kidney
stone formation.
Bowel regulation
Avoid constipation and straining
Routine defecation schedule
Stop smoking
To reduce chronic coughing reduces downward pressure on the pelvic floor
Weight reduction
Excessive body weight affects bladder pressure, blood flow, and nerves
30. Absorbent products are pads or garments designed to
absorb urine to protect the skin and clothing.
ADVANTAGES DISADVANTAGES
Absorb 20-300ml of urine dependency
Used in intractable incontinence as
an adjunct to behavioral and
pharmacologic therapies
Improper use of absorbent products
may contribute to skin breakdown
and urinary tract infections.
31. Urethral occlusive devices are artificial devices
that may be inserted into the urethra or placed
over the urethral meatus to prevent urinary
leakage.
These devices are palliative measures to prevent
involuntary urine loss.
ADVANTAGES DISADVANTAGES
Keep the patient drier they may be more difficult to put
and expensive
Best suited for an active woman
with incontinence who does not
desire surgery
Devices may be more difficult to
change.
The urethral plug may fall into the
bladder or fall off the urethra.
32. Indwelling urethral catheters
The usual practice is to change indwelling catheters once
every month
All indwelling catheters in the urinary bladder for more
than 2 weeks become colonized with bacteria.
Indwelling urethral catheters are a significant cause of
urinary tract infections
Another problem of long-term catheterization is bladder
contracture
Anticholinergic therapy and intermittent clamping of the
catheter in combination is beneficial.
33. ADVANTAGES DISADVANTAGES
usually smaller
more patient-friendly.
Bowel perforation is known to occur
with first-time placement of
suprapubic tubes
more sanitary for the individual, No
risk of urethral damage
are contraindicated in persons with
chronic unstable bladders or intrinsic
sphincter deficiency
Bladder spasms occur less often Does not prevent bladder spasms from
occurring in unstable bladders
When the tube is removed, the hole in
the abdomen quickly seals itself within
1-2 days.
34. Of all 3 possible options (ie, urethral
catheter, suprapubic tube, intermittent
catheterization), intermittent
catheterization is the best solution for
bladder decompression of a motivated
individual.
The bladder must be drained on a regular
basis, either based on a timed interval or
based on bladder volume.
Amount drained each time should not
exceed 400-500 mL.
35. Weakness of levator muscles results in pelvic
prolapse and stress incontinence .
Used in both stress incontinence and urge
incontinence.
1. Find your pelvic floor muscles.
2. Squeeze your pelvic floor muscles as hard as
you can and hold them (squeeze 3-5 sec and
relax for 5 sec).
3. Do sets of repetitions of squeezing (start with
5 repetitions: squeeze, hold, relax).
4. Increase lengths, intensity, and repetitions
every couple of days.
5. Perform Kegel exercises 3-4x during the day
36. Used in stress incontinence in premenopausal
women.
A single weight is inserted into the vagina and held in
place by tightening the perivaginal muscles (levator
ani muscles) for as many as 15 minutes. As the levator
ani muscles become stronger, the exercise may be
increased to 30 minutes.
This exercise is performed twice daily.
The best results are achieved when Kegel exercises are
performed with intravaginal weights.
37. Biofeedback is an intensive therapy
Biofeedback allows the patient to correctly
identify the pelvic muscles that need
rehabilitation.
Biofeedback is best used in conjunction with
pelvic floor muscle exercises and bladder
training.
The best biofeed back protocol is one that
reinforces levator ani muscle contraction with
inhibition of abdominal and bladder
contraction.
38. Electrical stimulation is a more sophisticated form of
biofeedback used for pelvic floor muscle rehabilitation.
This treatment involves stimulation of levator ani muscles
using painless electric shocks.
Like biofeedback, pelvic floor muscle electrical
stimulation has been shown to be effective in treating
female stress incontinence, as well as urge and mixed
incontinence.
39. Bladder training generally consists of self-education,
scheduled voiding with conscious delay of voiding,
and positive reinforcement
Patients urinate according to a scheduled timetable
rather than the symptoms of urge.
Initially, the interval goal is determined by the
patient's current voiding habits and is not enforced at
night.
The first voiding interval may be increased by 15- to
30-minute increments with slow increments.
40. Sympathomimetic drugs, estrogen, and tricyclic
agents increase bladder outlet resistance to improve
symptoms of stress urinary incontinence.
Pharmacologic therapy for stress incontinence and an
overactive bladder may be most effective when
combined with a pelvic exercise regimen.
The 3 main categories of drugs used to treat urge
incontinence include anticholinergic drugs,
antispasmodics, and tricyclic antidepressant agents.
41. Conjugated estrogen increases the tone of urethral muscle and
strengthen pelvic muscles, which is important in urethral
support (prevents urethral hypermobility)
Improves uretheral mucosal seal effect, which is important in
urethral function (prevents intrinsic sphincter deficiency).
Improvement seen in 29-66% of women.
DOSAGE:
0.625 mg PO qd for 21 consecutive days discontinue at 3- to 6-
mo intervals.
2-4gms of cream may be administered intravaginally qd in a
usual cyclic regimen.
42. First line medicinal therapy in women with urge
incontinence.
They are effective in treating urge incontinence because
they inhibit involuntary bladder contractions.
Adverse effects include blurred vision, dry mouth,
palpitations, drowsiness, and facial flushing.
Ex: Propantheline bromide - 15 mg PO tid/qid
Dicyclomine hydrochloride- 10-20 mg PO tid
Hyoscyamine sulfate- 0.125 mg PO q4h
43. Direct spasmolytic action on the smooth muscle of the bladder.
Competitive muscarinic receptor antagonist.
The adverse-effect profile of antispasmodic drugs is similar to that
of anticholinergic agents.
Ex: Solifenacin succinate - 5 mg PO qd
Darifenacin- 7.5 mg PO qd(Do not exceed 7.5 mg PO qd in
patients with moderate hepatic impairment)
Oxybutynin
Tolterodine- 2 mg PO bid
44. They function to increase norepinephrine and serotonin
levels.
In addition, they exhibit anticholinergic and direct muscle
relaxant effects on the urinary bladder.
It has alpha-adrenergic effect on the bladder neck and
antispasmodic effect on detrusor muscle.
It has Local anesthetic effect on bladder mucosa
Ex: Imipramine-10-50 mg PO qd/tid
Amitriptyline- 10 mg/d PO; titrate prepration by 10 mg/wk
until maximum dose of 150 mg is reached
45. Oral Osmotic Delivery System (OROS).
Ditropan XL: innovative drug delivery system.
Tablet has a bilayer core that contains a drug layer
and a push layer that contains osmotic components.
Ditropan XL achieves steady-state levels over a 24-h
period.
It avoids first-pass metabolism of the liver and upper
GI tract to avoid cytochrome P450 enzymes.
It has excellent efficacy with minimal adverse effects.
46. BOTEXINJECTION
Endoscopic procedure/outpatient
Botulinum toxin type A
Onset within 2 days to 2 weeks after treatment
Effect lasts ~ 6 months
Side effects rare and minor (<10%)
Efficacy:
Reduction from baseline incontinence: 40%-80%
65%-87% of patients became completely continent
(between caths) after Botox
Main issue is cost.
47.
48.
49. CATEGORY B CATEGORY C CATEGORY D CATEGORY X
Dicyclomine Propantheine Bromide
Hyoscyamine sulfate
Imipramine Conjugated
estrogen
Oxybutynin Solifenacin succinate
Derifenacin
Tolterodine
Amitriptyline
Trospium
50. Surgical care for stress incontinence involves
procedures that increase urethral outlet
resistance, which include the following:
Bladder neck suspension
Periurethral bulking therapy
Sling procedures
Artificial urinary sphincter