2: Male Incontinence

Question 1

What two types of incontinence occur in males

Answer 1

Urge

Overflow

Question 2

What is urge incontinence

Answer 2

Over-active bladder results in contraction. This increases pressure leading to rise in intra-vesical pressure and subsequent leakage of urine

Question 3

What is overflow incontinence

Answer 3

Complication of chronic retention. Where there is damage to sacral plexus resulting in loss sensation. As the bladder fills, it becomes grossly distended leading to dribbling

Question 4

What cause overflow incontinence most commonly

Answer 4

BPH

Question 5

In which gender is incontinence more common

Answer 5

Males (3:1)

Question 6

What are the two types of LUTS

Answer 6

Storage and Voiding

Question 7

What is a mnemonic to remember storage symptoms

Answer 7

FUNI

Question 8

What are the storage LUTS

Answer 8

Frequency

Urgency

Nocturia

Incontinence

Question 9

What is a mnemonic to remember voiding symptoms

Answer 9

UR HITS

Question 10

What are the voiding symptoms

Answer 10

Urinary Retention

Hesitancy

Incomplete emptying

Terminal dribbling

Stream poor

Question 11

what investigations are ordered in men with LUTS

Answer 11

• Urinalysis
• DRE
• PSA
• Bladder Diary
• Urodynamic studies
• Internal prostate symptom score

Question 12

in males how are voiding symptoms managed conservatively

Answer 12

Bladder training

Question 13

what first-line medication is indicated for voiding symptoms

Answer 13

A-blocker

Question 14

what second line medication is used for voiding symptoms

Answer 14

Finasteride

Question 15

if missed storage and voiding what is indicated

Answer 15

Add anti-muscarinic if not managed by above

Question 16

If over-active bladder, what conservative measures are taken

Answer 16

bladder training

Question 17

what medication is offered for over-active bladder

Answer 17

anti-muscarinic

Question 18

if patient is bothered by nocturia, what is offered

Answer 18

moderate fluid intake at night

Question 19

what medication is offered in nocturia

Answer 19

40mg furosemide in later afternoon or desmopressin

Question 20

what are the two main causes of bladder outlet obstruction in males

Answer 20

BPH
TCC
Urethral stricture

Question 21

how is urethral stricture investigated

Answer 21

retrograde urethrogram or anterograde cystogram

Question 22

how is urethral stricture managed

Answer 22

internal urethrotomy

Question 23

what does bladder outlet obstruction cause

Answer 23

acute or chronic urinary retention

Question 24

what are complications of acute urinary retention

Answer 24

• AKI

- Obstructive nephropathy

Question 25

what are complications of chronic urinary retention

Answer 25

• UTI
• Urolithiasis
• Overflow incontinence

Question 26

what is obstructive uropathy

Answer 26

obstruction urine flow at any level causing back-flow of pressure and hydronephrosis. If untreated hydronephrosis is untreated it can compress blood vessels decreasing perfusion and causing atrophy

Question 27

what are the two types of chronic urinary retention

Answer 27

• Low-pressure

- High-pressure

Question 28

what is low pressure chronic retention

Answer 28

• Normal creatinine

- No hydronephrosis

Question 29

what is high pressure chronic retention

Answer 29

• Raised creatinine

- Normal pressure hydronephrosis

Question 30

how are patients with high pressure chronic retention managed

Answer 30

intermittent self-catheterisation