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Question 1

What are the main types of urinary incontinence?

Answer 1

Stress urinary incontinenceUrge urinary incontinenceMixed urinary incontinenceOverflow urinary incontinence

Question 2

Why does urinary incontinence occur?

Answer 2

It occurs when the bladder pressure is greater than the urethral sphincter pressure. Either due to:– detrusor pressure is high– sphincter pressure is low

Question 3

What is a major factor which helps to maintain continence?

Answer 3

Strength and support of the urethra by the pelvic floor muscles and ligaments.

Question 4

What is urinary incontinence?

Answer 4

The complaint of involuntary leakage of urine. – has a massive impact on quality of life

Question 5

Describe stress urinary incontinence

Answer 5

the complaint of involuntary leakage on effort or exertion, or on sneezing or coughing

Question 6

Describe urge urinary incontinence

Answer 6

the complaint of involuntary leakage (of urine) accompanied by or immediately proceeded by urgency

Question 7

Describe mixed urinary incontinece

Answer 7

the complaint of involuntary leakage (of urine) associated with urgency and also with exertion, effort, sneezing or coughing

Question 8

Describe overflow incontinence

Answer 8

Retention of urine causing the bladder to swell. Can be low pressure and pain free.

Question 9

What are some risk factors for incontinence?

Answer 9

Pregnancy and childbirthAnatomical abnormalitiesObesityAgeIncreased intra-abdominal pressureUTIMenopauseDrugs– anything that weakens the pelvic floor muscles

Question 10

What is the most common form of incontinence?

Answer 10

1. Stress urinary incontinence2. Mixed urinary incontinence3. Urge urinary incontinence

Question 11

What is the correlations of age and the incidence of incontinence?

Answer 11

Incidence steadily increases with age

Question 12

What should you find out from the patient’s history?

Answer 12

– Record amount of fluid passed over 2-3 days (helps for categorisation, determine if intermittent or continuous)– Previous surgery on plelvic floor– Childbirth

Question 13

What else can cause an increase in frequency of urination?

Answer 13

Intravesicular inflammatory conditionUrinary tract infectionStone in the bladderTumour

Question 14

What would you typically do for an examination for paitents you suspect have incontinence?

Answer 14

Height and weightAbdominal examinationDigital rectal examination– prostate exam in malesFemales– external genitalia– vaginal exam

Question 15

What are some typical investigations?

Answer 15

Urine dipstickBasic, non-invasive urodynamics– frequency-vol chart– bladder diary for about 3 days– post-micturition residual volume for patients with voiding dysfunction

Question 16

What are some other investigations that are not always necessary?

Answer 16

Invasive urodynamics - pressure flow studiesPad testCytoscopy

Question 17

Describe what pressure flow studies measure

Answer 17

Measure abdominal pressureMeasure internal bladder pressureMeasure detrusor pressure (ab pressure minus internal bladder pressure)

Question 18

Give some methods of conservative management

Answer 18

Change fluid intakeLose weightStop smokingDecrease caffeine and fizzy drinks intakeAvoid constipationTimed voiding, have a fixed schedule

Question 19

What is contained incontinence?

Answer 19

Patients who are not suitable for surgery and who have failed conservative or medical management.

Question 20

Give some examples of contained incontinence

Answer 20

–Indwelling catheter, wither urethral or suprapubic– Sheath device (adhesive condom attached to catheter tubing and bag)– Incontinence pads

Question 21

What is a specific treatment for stress urinary incontinence?

Answer 21

Pelvic floor muscle training

Question 22

What is a specific treatment for urge urinary incontinence?

Answer 22

Bladder training such as having a schedule of voiding

Question 23

Describe bladder training

Answer 23

Void every hour Must not void in betweenIncrease times between voiding until up to 2-3 hoursUndertake for 6 weeks

Question 24

Describe some pharmacological treatments

Answer 24

Duloxetine– NA and serotonin uptake inhibitor. Increases activity of external urethral sphincter during filling phase. Is an alternative to surgery and not used a s a first choice. Anticholinergics– Act on M2 and M3 receptors to reduce contraction of detrusor muscle. Botulinum toxin– Inhibits ACh at pre-synaptic neuromuscular junction causing targeted flaccid paralysis–Lasts for 3-6 months

Question 25

What are the main permanent surgical interventions for women?

Answer 25

Low tension vaginal tapesOpen retropubic suspension procedureClassic fascial sling procedure

Question 26

Describe low-tension vaginal tapes

Answer 26

Most commonSupport the mid urethra with polypropylene meshIs >90% successful

Question 27

Describe the open retropubic suspension procedure

Answer 27

Correct anatomical position of the proximal urethra and improves urethral supprt

Question 28

Describe the classic fascial sling procedure

Answer 28

Supports urethra and increases bladder outflow resistance. Involved autologous transplantation of the fascia lata or rectus fascia

Question 29

What is a surgical procedure for women which is used for temporary relief of symptoms?

Answer 29

Intramural bulking agents– improve ability of urethra to resist abdominal pressure – Inject autologous fat, silicone, collagen or hyaluron-dextran polymers

Question 30

What are the surgical procedures which are used in males?

Answer 30

Artificical urinary sphincterMale sling procedure

Question 31

Describe the artificial urinary sphincter surgery

Answer 31

Cuff is a mechanical device which stimulate the action of a normal sphincter to close the urethra. – can have problem with infection, erosion and device failure.

Question 32

Describe the male sling procedure

Answer 32

Corrects iatrogenic caused incontinence. Uses a bone-anchored tape in order to support the urethra.

Question 33

What is the normal capacity of the bladder?

Answer 33

300 - 700 ml– can be more in different people