13- Urinary Incontinence And Pelvic Prolapse

Question 1

What is urinary incontinence?

Answer 1

Involuntary loss of urine as a result of arise in intravesical pressure that exceeds intraurethral pressure in the absence of bladder contraction

Question 2

What is the second most common cause of urinary incontinence?

Answer 2

Detrusor instability

Spontaneous Involuntary bladder contractions while Patient trying to inhibit micturition

Question 3

What are the different types of incontinence?

Answer 3

Mixed incontinence
Overflow incontinence
Urogenital fistula

Question 4

What is mixed incontinence?

Answer 4

Combined stress incontinence and detrusor instability

Most common in male

Question 5

What is overflow incontinence?

Answer 5

Defect in urination causing the marked distension of the bladder leading to leaking as pressure eventually overrides intact sphincter

Question 6

What is the urogenital fistula

Answer 6

Anatomical defect causing a tract between the urinary system and some other system most often vagina causing a bypass of the normal continence mechanisms

Question 7

What are the sources of physical damage?

Answer 7

Pregnancy and vaginal delivery constitue the primary source of injury to the supporting structures leading to urethral hypermobility and stress incontinence
Neurologic injury

Question 8

What are some common causes of detrusor hyperreflexia?

Answer 8

Multiple sclerosis
Cerebrovascular accidents
Spinal injuries or tumors
Congenital spinal cord abnormalities

Question 9

What is the effect of genital prolapse?

Answer 9

Descent of the anterior vaginal wall resulting in urethra or bladder neck folding on itself
Can have profound effects on lower urinary tract function

Question 10

What is the Q-tip test?

Answer 10

Resting and straining angles are measured several times

Test is positive for urethral hypermobility when the straining angle is greater than 30-35 degree

Question 11

What is the eyeball cystometry?

Answer 11

Cathéter is placed transurethrally
Bladder progressively filled by pouring sterile water into a syringe
Record patient first sensation to void and max cystometric capacity
Involuntary bladder contractions are suggested by rising meniscus
Also allows for the measurement of the residual urine

Question 12

What is the stress testing?

Answer 12

Simple clinical test to demonstrate urinary leakage
Patient cough, perform valsalva to increase intra abdominal pressure to cause stress incontinence
Most provocative with full bladder and patient standing

Question 13

What is the treatment for urinary incontinence?

Answer 13

Non surgical first line interventions: lifestyle interventions, pelvic muscle training
Surgical- tension free transvaginal sling, burch, bulking procedures

Question 14

What is the treatment of detrusor instability?

Answer 14

Non pharmacologic- bladder retraining, bio feedback

Pharmacological- anti muscarinic, tricyclic anti depressants to cause muscle relaxation

Question 15

What is a pelvic organ support defect?

Answer 15

Defect in the support of the pelvic organs causing the descent of these organs
Not necessarily symptomatic
Defined as the anatomic presenting part:
Cystocele- prolapse bladder
Rectocele- prolapse rectum
Uterine prolapse

Question 16

What are the classification of the prolapse?

Answer 16

Stage 0- no prolapse
Stage 1- leading edge of the prolapse>1 cm above hymen
Stage 2- leading edge is equal or less than 1 cm from hymen
Stage 3- more than 1 cm below hymen but not the total vaginal length
Stage 4- complete eversion of the vagina

Question 17

What is the treatment for prolapse?

Answer 17

Mild and asymptomatic patients do not require treatment
Pessary- non surgical supportive or space occupying device which reduce prolapse
Surgical- hysterectomy with resuspension procedure, anterior or posterior repair of vagina(colporrhaphy)