Urinary Incontinence

Urinary Incontinence
By:Stephen J. Titus MD

Objectives
* Define the main causes of urinary incontinence.
* Formulate an approach to their diagnosis.
* Identify the treatment strategies for each.
* Remind each of us to not eat Yellow Snow

Impact
* Direct cost of treatment in 1995 was $26.3 billion
* More common in women then men
* >1/3 women >65 have some degree of incontinence
* Fewer than 50% will raise complaint to physician

Types of Urinary Incontinence
* Urge Incontinence
* Stress Incontinence
* Mixed Incontinence
* Overflow Incontinence
* Functional Incontinence
* Incontinence due to secondary causes
o Medications
o Urinary Tract Infections
o Stool Impaction
o Hyperglycemia
o Heart Failure
o Interstitial Cystitis
o Bladder Malignancies

Medications
* Diuretics
* Caffeine
* Alcohol
* Anticholinergics
* Alpha agonists
* Beta agonists
* Sedatives/Antidepressants/Antipsychotics
* Narcotics
* Alpha blockers
* ACE inhibitors(cough)
* Mixed
* Stress

Notre Dame
Evaluation
* History
* Physical
* Post Void Residual
* Laboratory
o Urinalysis (with culture if infection suspected)
o Renal function
o Fasting Glucose
* Urodynamic Testing

Venus de Milo
Treatment
* Urge Incontinence
* Stress Incontinence
* Mixed Incontinence
* Overflow Incontinence
* Functional Incontinence

Napolean’s Tomb
Cases
Summary
* Most cases of urinary incontinence can be diagnosed and initially treated with an H&P and routine labwork
* First line treatment for Urge, Stress and Mixed incontinence is behavioral and centered around Kegels
* Overflow: Think prostate in men, scar tissue /previous surgery in women.

Resources
Urinary Incontinence.ppt

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Pediatric Urinary Tract Infections

Pediatric Urinary Tract Infections
By: Joshua A. Hodge, Maj, USAF, MC
Staff Family Physician
Andrews AFB, MD

Overview
* Background
* Diagnosis
* Treatment
* Follow up
* Prevention
* Imaging
* Vesiculoureteral reflux (VUR)
* Summary

Diagnosis
* Single organism identified on culture
* Urinalysis
* Blood cultures not useful

Treatment
* Initiate immediately after culture drawn
* Oral route preferred
* 7-14 day course is standard

Follow Up
* AAP Recommendation: 48 hours
Prevention

* Rates of recurrence
* Prophylactic antibiotics
* Circumcision

Imaging
* Who to image?
o AAP
* Renal ultrasound
o GU tract anatomy
o Evaluate renal scarring
* DMSA (renal cortical scan)
o Differentiates pyelonephritis from cystitis
o Assesses renal scarring
* Cystogram- identify and grade vesicoureteral reflux (VUR)
o Voiding cystourethrogram (VCUG)
o Radionuclide cystogram (RNC)

Vesicoureteral Reflux (VUR)
* Concern for pyelonephritis & renal scarring
* Prevalence in females
* Standard treatment options
* Unclear if clinical benefits to treating VUR

Summary
* Urine culture necessary for diagnosis
* Short courses of antibiotics may be as effective as longer courses
* Prophylactic antibiotics are an option but may not provide much clinical benefit
* Routine imaging does not appear to affect outcomes
* Diagnosing VUR does not appear to affect outcomes

References
Pediatric Urinary Tract Infections.ppt

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Diabetes: The 2007 Guidelines

Diabetes: The 2007 Guidelines
By:Kevin E. Moore, M.D.
LTC, MC
Residency Director
NCC-DACH Family Medicine Residency


ADA 2007 Clinical Practice Recommendations

* Why is this important?
* Current screening guidelines
* 6 cornerstones of diabetes
* New developments


Medical Management Can Change All of the Above
Screening
Risk Factors
* Family History
* Obesity (BMI > 25)
* Race/Ethnicity (African-American, Hispanic-American, Native Americans, Asian Americans, Pacific Islanders)
* Age > 45
* Hypertension (> 140/90)
* HDL Cholesterol < 35
* Triglycerides > 250
* History of GDM
* History of Macrosomia
* Polycystic Ovarian Disease
* Previous Abnormal Screening
* Physically Inactive
* Vascular Disease

Screening Recommendations
Repeat and Confirm all Screening Tests in 24 Hours!
Screening Tests
Cornerstones of Diabetes Management?
* Glycemic Control
* Hypertension
* Hyperlipidemia
* Nephropathy
* Retinopathy
* Foot Care
Drug Therapy
Nutrition Therapy
Screening Tests for Albuminuria
Screening Test Results
Annual Foot Exam
Risk Factors for Foot Disease
New Developments - Prevention
New Developments - Children

Diabetes: The 2007 Guidelines.ppt

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