Urinary Incontinence

Question 1

Types

Answer 1

Stress
Urge
Mixed

Question 2

Stress UI

Answer 2

Occurring when the intra-abdominal pressure increases
e.g. when coughing, straining, laughing, or lifting.

Due to weakness of the pelvic floor muscle

Commonly seen post-partum

Question 3

RF for Stress UI

Answer 3

Obesity
Post-menopausal
Pelvic surgery e.g. TURP - external sphincter damage

Question 4

Urge UI

Answer 4

Overactive bladder
- uninhibited bladder contraction

Can be due to:

• neurogenic causes (such as a previous stroke)
• infection
• malignancy
• idiopathic
• Medication - cholinesterase inhibitors

Question 5

Overflow UI

Answer 5

Due to chronic urinary retention causing

stretching of the bladder wall - damage to the efferent fibres of the sacral reflex and loss of bladder sensation

Question 6

Investigations

Answer 6

Bladder diary for min 3 days
QoL questionnaires - quantify severity of the condition

Genital examination and DRE

Midstream urine dipstick

Post void bladder scan

Urodynamic assessment

Outflow urodynamics

Cystoscopy

Question 7

Urodynamic assessment

Answer 7

Intravesicular and intra-abdominal pressures

Question 8

Outflow urodynamics

Answer 8

Measure detrusor muscle activity against urine flow rate

Question 9

Outflow urodynamics for overflow UI

Answer 9

high intra-vesicular pressure with poor urine flow

Question 10

Management for stress incontinecne

Answer 10

1. Pelvic floor exercises - 3x for 3 months
2. Duloxetine - SSRI
3. Oxybutynin or tolterodine - anti - muscarinic
4. tension-free vaginal tape
5. Open colposuspension
6. intramural bulking agents
7. Artificial urinary sphincter

Question 11

Management for urge incontinence

Answer 11

1. Bladder training - 6 weeks
2. Oxybutynin
3. Mirabegron
4. Vaginal oestrogen cream in post menopausal women
5. Botulinum toxin A injections
6. Clam cystoplasty
7. Sacral neuromodulation

Question 12

Conservative management

Answer 12

Weight loss

Reducing caffeine, fizzy drinks and alcohol intake

Avoid drinking excessive fluid volumes

Smoking cessation

Question 13

Open colposuspension

Answer 13

Elevation of the bladder neck and urethra through a lower abdominal incision

Question 14

Side effects of oxybutynin

Answer 14

Dry mouth
Constipation
Blurred vision

Question 15

Mirabegron

Answer 15

B3 agonist

• decreases sensitivity

Question 16

Botulinum toxin A injections use and side effects

Answer 16

Every 6 - 9 months
can cause:

• retention -requires catheterisation
• incomplete emptying - requires intermittent self catheterisation

Question 17

Clam cystoplasty

Answer 17

Detubularised segment of bowel is inserted into the bladder wall to increase bladder capacity and disrupts muscle contraction

Can cause:

• retention
• metabolic hypercholaemic metabolic acidosis
• Obstruction - small bowel produced mucus forming infection or stones
• Adenocarcinoma at junction

Question 18

Sacral neuromodulation

Answer 18

Electrical stimulation of S2- S3 used in neurological patients - non relaxing sphincter and overactive bladder

Lasts 5 years and less invasive

Question 19

Normal flow volume rate

Answer 19

15ml/second - male

20ml/second - females

Question 20

Treatment of nocturnal polyuria

Answer 20

Desmopressin