8 - Gynae - Disorders of the Urinary Tract - Urinary Stress Incontinence

Question 1

invol leakage of urine on ?/?/?/?
commonly due to urethral ? weakness
only diagnosed after excluding ? after ?

Answer 1

effort/exertion/coughing/sneezing
sphincter
OAB after cystometry

Question 2

Accounts for ? % of incontinence in females, occurs to varying degree in >?% of all women.

Answer 2

50%

>10%

Question 3

Important causes include ? and ? delivery, esp with ? labour and ?, incr risk with ? and ?
? commonly coexists but not always related
prev ? is a RF

Answer 3

preg and vaginal del
prolonged labour and forceps
obesity and age
prolapse
hysterectomy

Question 4

Mechanism of incontinence- incr in ? - ? compressed and pressure rises. Normally, bladder ? is ? compressed so ? difference in ?. But if bladder neck slipped ? ? floor due to ? ?, lead to pressure difference. Rest of ? and pelvic floor unable to compensate > ?

Answer 4

IAP
bladder
neck
equally
no
pressure
below pelvic floor
weak supports
urethra
incontinence

Question 5

Clinical features - Hx points

• what must be assessed?
• stress incont predominates but some also complain of ?,? or ? incontinence
• what may coexist due to childbirth?

Answer 5

the disruption to pts life
urgency, freq, urge incont
faecal incont

Question 6

Clinical features - Ex points.
-usually do what? which usually reveals what?
-when might leakage be seen?
what must be ruled out with abdo palp?

Answer 6

Sims speculum - cyst/rectocoele
with coughing - make them cough
distended bladder

Question 7

Ix - what to exclude infection?

-when would you do cystometry?

Answer 7

urine dipstick

to exclude OAB if surgery considered
or if OAB fails to respond to medical trt

Question 8

Diff between Urodynamic stress incontinence and stress incontinence?

Answer 8

USI = disorder Dx’d by cystometry

stress incont = a symptom - the major Sx of USI but also can be due to OAB or overflow incont

Question 9

MGMT - 3 possible lifestyle changes?

Answer 9

lose wt if obese, address chronic cough eg stop smoking, reduce excessive fluid intake

Question 10

MGMT - conservative

• strengthen ? ? - for how long and by who? what should be assessed before trt?
• encourage to continue during further trts
• what are used and work in >?%of pts

Answer 10

pelvic floor muscles
1st line = 3m PFMT by physio
strength of PFM by digitally assessment

vaginal cones - >50%

Question 11

MGMT - medical

• for mod-sev USI?
• This is an SNRI - enhancing ? ? ? activity via centrally mediated pathway.
• Ass w dose-dep ? in ? of incontinence.
• SE: 25% get ?, dry mouth, ?, dizziness, ? or drowsiness

Answer 11

duloxetine
urethral striated sphincter
decr in freq on incont
SE - nausea, dry mouth, dyspepsia, dizziness, insomnia or drowsiness

Question 12

MGMT - surgical

• considered when other trts fail and impact on ?
• What are currently 1st line? cure up to ?%
• 4 main complx of these?

Answer 12

QoL
TVT or TOT (torsion free vaginal tape or Trans obturator tape)
90%
bladder perf, post op voiding difficulty, bleeding, infection

Question 13

MGMT - surgical

-What trt is good if other fail /elderly pt? why? immediate success rate? what other effect?

Answer 13

Injectable periurethral bulking agents
-> low morbidity
40-60%
also long term decline in incont