16: Urinary incontinence and pelvic prolapse: Pathophysiology, evaluation, and medical management

Question 1

Define “Urinary incontinence”.

Answer 1

Complaint of any involuntary leakage of urine.

Question 2

What symptom describes the complaint of involuntary leakage on effort, exertion, sneezing, or coughing?

Answer 2

Stress urinary incontinence.

Question 3

Describe the symptom of “Urgency” in urinary incontinence.

Answer 3

Complaint of a sudden compelling desire to pass urine, which is difficult to defer.

Question 4

What is “Urgency urinary incontinence”?

Answer 4

Complaint of involuntary leakage accompanied by or immediately preceded by urgency.

Question 5

Which type of incontinence is described as a voluntary loss of urine associated with a change of body position, such as rising from seated or lying positions?

Answer 5

Postural incontinence.

Question 6

Define “Nocturnal enuresis”.

Answer 6

Complaint of involuntary loss of urine that occurs during sleep.

Question 7

What term describes involuntary leakage associated with both urgency and activities like exertion, effort, sneezing, or coughing?

Answer 7

Mixed incontinence.

Question 8

What does “Continuous urinary incontinence” refer to?

Answer 8

Complaint of continuous leakage.

Question 9

Which type of incontinence occurs when the woman is unaware of how the urinary incontinence happened?

Answer 9

Insensible incontinence.

Question 10

Define “Coital incontinence”.

Answer 10

Complaint of involuntary loss of urine with coitus.

Question 11

What pharmacologic agents are classified as Sympathomimetics that can affect the lower urinary tract?

Answer 11

Ephedrine, methylphenidate, cocaine, amphetamine.

Question 12

What potential effects on the urinary tract can Sympathomimetics cause?

Answer 12

They can increase outlet resistance, exacerbate obstructive symptoms/overactive bladder symptoms, decrease detrusor contractility, and precipitate retention.

Question 13

Name the pharmacologic agents classified as Sympatholytics.

Answer 13

Terazosin, doxazosin, tamsulosin, alfuzosin, silodosin.

Question 14

What is the potential effect of Sympatholytics on the urinary tract?

Answer 14

What is the potential effect of Sympatholytics on the urinary tract?

Question 15

Which agents are categorized as Anticholinergics that might impact the lower urinary tract?

Answer 15

Oxybutynin, fesoteridine, solifenacin, trospium, darifenacin.

Question 16

How do Anticholinergics potentially affect the urinary tract?

Answer 16

They can contribute to urinary retention, especially in patients with outlet obstruction.

Question 17

List the pharmacologic agents that are Diuretics, as per the table.

Answer 17

Furosemide, thiazides, spironolactone, triamterene, bumetanide.

Question 18

How do Diuretics directly affect the bladder?

Answer 18

They do not affect the bladder directly. However, due to increased urine production, they can aggravate incontinence problems.

Question 19

What are the main components assessed during a focused pelvic examination?

Answer 19

External genitalia and vagina, urethra, bladder, cervix, uterus, adnexa/parametria, and anus and perineum.

Question 20

When examining the external genitalia and vagina, what aspects related to general appearance are assessed?

Answer 20

Hair distribution, the presence of lesions, estrogen effect, and discharge.

Question 21

During the pelvic examination, which structures are checked for general appearance, lesions, and discharge?

Answer 21

External genitalia, vagina, and cervix.

Question 22

Which pelvic structures are evaluated for masses, tenderness, and other conditions during the examination?

Answer 22

Urethra, bladder, cervix, uterus, and adnexa/parametria.

Question 23

How is the uterus examined during a focused pelvic examination?

Answer 23

It is evaluated for size, contour, position, mobility, tenderness, consistency, descent, or support

Question 24

When assessing the adnexa/parametria during the pelvic examination, which conditions or signs should be looked for?

Answer 24

Masses, tenderness, organomegaly, and nodularity.

Question 25

Based on modern medical practices, why might a detailed assessment of the vagina’s estrogen effect be crucial for post-menopausal women?

Answer 25

Lower estrogen levels post-menopause can lead to vaginal atrophy, with symptoms like dryness, irritation, and dyspareunia, impacting quality of life and sexual function.

Question 26

During a pelvic examination, what are the primary concerns when inspecting the anus and perineum?

Answer 26

During a pelvic examination, what are the primary concerns when inspecting the anus and perineum?

Question 27

What are the criteria for Stage 0 in the Baden-Walker Classification and the POP-Q Staging Criteria?

Answer 27

Aa, Ap, Ba, Bp at –3 cm, and C or D ≤ – (tvl – 2) cm

Question 28

Which stage in the Baden-Walker Classification and the POP-Q Staging Criteria has criteria that do not meet Stage 0 and has a leading edge < –1 cm?

Answer 28

Stage I

Question 29

For which stage is the leading edge ≥ –1 cm but ≤ +1 cm in the Baden-Walker Classification and the POP-Q Staging Criteria?

Answer 29

Stage II

Question 30

Which stage in the Baden-Walker Classification and the POP-Q Staging Criteria has a leading edge that’s more than +1 cm but less than + (tvl – 2) cm?

Answer 30

Stage III

Question 31

In the Baden-Walker Classification and the POP-Q Staging Criteria, for which stage is the leading edge ≥ + (tvl – 2) cm?

Answer 31

Stage IV

Question 32

If a patient has a leading edge of exactly +1 cm based on the Baden-Walker Classification and the POP-Q Staging Criteria, which stage would they fall under?

Answer 32

Stage II