배뇨장애 II 1. hydronephrosis 2. urinary incontinence Hanjong Park, PhD, RN 1

1. hydronephrosis 2

Hydronephrosis( 수신증 ) 정상적인 요의 흐름이 폐쇄되어 신우와 신배가 팽창된 상태 원인 : 결석, 종양, 반흔조직, 염증, 꼬임, 전립선 비대 ( 남 ), 요로 폐색 진단 : 초음파 검사, 경정맥 요로 조영술, 사구체 여과율 치료와 간호 : 근본적 치료 : 폐색 없애도록 ( 제거 후 반사적 이뇨로 체액부족 올 수 있음 ) 항생제 (3-4 주 ): 감염증 + 폐색 신장절제술 : 신기능 상실시 폐색이 어려운 경우 : 경피적 신장, 요관, 혹은 방광에 도관 삽입하여 배뇨 3 김금순 외 (2012) Lewis et al.(2014)

4 Hydronephrosis( 수신증 ) Detail.do?contentId= forums.com/index.php?action=gallery;sa=view;id=9287

2. Urinary incontinence 5

Urinary Incontinence(UI, 요실금 ) Definition: Involuntary, unpredictable expulsion of urine from the bladder and is encountered in several temporary and permanent conditions Related to bladder and urethral dysfunction UI occurs when bladder pressure exceeds urethral closure pressure Prevalence men(1.5-5%) women(10-25%) under the age of 65 years Men(20%) women(33%) over age 60, noninstitutionalized 50% over age 60, institutionalized 6 Lewis et al.(2014)

Causes of Urinary Incontinence DRIP Delirium, dehydration, depression Restricted mobility, rectal impaction Infection, inflammation Polyuria, polypharmacy 7 Lewis et al.(2014)

Diagnostic studies of Urinary Incontinence History, physical assessment, bladder log or voiding record Onset, factors or conditions provoking urinary leakage Pelvic floor muscle Urinalysis: UTI, diabetes Postvoid residual(PVR) urine (cathterizaton or ultrasound) Urodynamic testing(e.g., ultrasound) 8 Lewis et al.(2014)

9 Table Drug therapy: drugs affecting lower urinary tract function (Lewis et al.(2014, p. 1087)

Urinary Incontinence( 요실금 )  Major types of incontinence: Stress I. ( 스트레스성 = 복압긴장성 요실금 ) : intermittent leakage of urine resulting from a sudden strain, such as a cough or sneeze Urge I. ( 긴박성 = 절박 요실금 ) : the inability to suppress a sudden need to urinate Overflow I.( 일류성 요실금 ) : characterized by dribbling, urgency, or frequency Reflex I.( 반사성 요실금 ) : condition occurs when no warning or stress) Incontinence after trauma or surgery( 외상 / 수술 후 요실금 ) Functional I.( 기능성 요실금 ) : inability to reach a toilet 10 읽을 부분 : Lewis et al.(2014, Fig Type of Urinary Incontinence, p. 1088) 김금순 외 (2012), table 14-2, p. 1511

11 Brigham and Women's Division of Urological Surgery at Brigham and Women's Faulkner Hospital(2015, September 28) Male Incontinence. Retrieved from and-services/urology/male- incontinence.aspx#.ViI65H7hAuU

Interventions for Urinary Incontinence  Behavioral therapy  Drug therapy  Surgical therapy 12 읽을 부분 : Lewis et al.(2014, Fig Interventions for Urinary Incontinence, p. 1089) 김금순 외 (2012), p

방광 재훈련  낮 동안 충분한 수분섭취를 격려 ( 금기가 아닐 경우 2,000-2,500ml/day 이상, 밤 8 시 이후 수분섭취 제한 )  이뇨제 복용은 낮 시간에  대상자의 배뇨양상에 기초해 예상 배뇨 시간표 작성  배뇨시간이 조절될 때까지 1-2 시간마다 배뇨하도록 함  방광을 완전히 비우도록 격려 13 김금순 외 (2012)

Kegel exercise( 골반저 근육운동 )  소변, 흐름을 멈춘다  위장, 다리, 둔부의 근육을 사용하지 말아야 한다  의자에 앉아 발은 마루바닥을 닿게하고, 무릎을 벌린 후 마치 배 뇨를 중지시키는 것처럼 회음부근육을 수축한다  주간에 4 회로 나누어 1 회에 열번씩 수축과 이완을 반복한다 ( 횟수 를 증가시킴 )  이때 배뇨하기를 원하면 실제로 배뇨하도록 하고 배뇨 중 멈추는 것을 시도한다 14 김금순 외 (2012)

Surgery for UI Mid-urethral tape procedures(minimally invasive slings): increasingly popular, generally performed through the vagina via a small cut made in the vaginal wall( 중부요도 현수법 ). Pubovaginal sling: This operation may be performed by two gynaecologists working together, using both a vaginal approach and an abdominal approach. Periurethral injections: A bulking agent is injected into the tissues of the urethra to create a cushioning effect. This bulking agent may be collagen or silicon. 15 김금순 외 (2012) Lewis et al.(2014)

Surgery for UI Mid-urethral tape procedures(minimally invasive slings): increasingly popular, generally performed through the vagina via a small cut made in the vaginal wall. 16 TOT(transobturator vaginal tape) TVT(Tension free vaginal tape) 김금순 외 (2012), Lewis et al.(2014)

Surgery for UI Pubovaginal sling: This operation may be performed by two gynaecologists working together, using both a vaginal approach and an abdominal approach. 17 Lewis et al.(2014)

Surgery for UI Periurethral injections: A bulking agent is injected into the tissues of the urethra to create a cushioning effect. This bulking agent may be collagen or silicon. 18 Lewis et al.(2014)

Surgery for UI  Possible Complications of Urinary Incontinence Surgery Difficulty with passing urine that lasts for a few weeks occurs in about two to five woman in 100 due to urethral outlet being elevated Up to five women in 100 have permanent difficulty passing urine. In these cases, there is often a pre-existing weakness in bladder emptying A urinary tract infection Injury to the bowel, urethra or bladder. 19 Lewis et al.(2014)

References 20 김금순 외 (2012). 성인간호학 II, 7 판. 수문사 Lewis, Sharon L.; Dirksen, Shannon Ruff; Heitkemper, Margaret M.; Bucher, Linda (2014). Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier Health Sciences. Kindle Edition.