Disorders Of The Bladder And Pelvic Floor

Question 1

Incontinence investigations

Answer 1

Urinalysis TRO ÚTI
Urine MC&S 
Bladder diary for at least 3 days
Postvoid residual urine 
Cystoscopy if recurrent UTI or hematuria
Ultrasound if suspected mass
Urodynamic testing if dx unclear, management fails or prior to surgery

Question 2

Managing incontinence generally

Answer 2

Fluids - 6-8 glasses, not before bed
Fibre
Physical activity - LOW, no heavy lifting
MHT - vaginal oestrogen
Toilet habits - only go when necessary
Referral to urogynae

Question 3

Managing stress incontinence

Answer 3

1. Pelvic floor training
2. Suburethral sling - retropubic midurethral sling/transobturator tape
3. Burch colposuspension
4. Urethral bulking agents

Question 4

Managing urge incontinence

Answer 4

1. Managing RF: medications, disease
2. LOW and bladder training
3. Anticholinergic meds: oxybutynin and tolderidone
4. B3 adrenergic agonist: Mirabegron
5. Botulinum toxin A injection
6. Sacral neuromodulation

Question 5

Management of POP

Answer 5

Modify RF and lifestyle: LOW, pelvic floor exercise, treat med conditions
Conservative: vaginal estrogen and vaginal pessary (ring better for anterior and apical POP)
Surgery for those who failed/don’t want conservative management

Question 6

Tests for POP

Answer 6

MSU dipstick and culture
PVR if cystocele to look for compression of urethra/voiding obst
Pelvic U/S or MRI before surgery
If indirect symptoms: urodynamic assessment, endoanal U/S, sigmoidoscopy, rectal manometry

Question 7

Cystic swelling under urethra that can be rescued by applying pressure, can have post micturition dribbling

Answer 7

Urethral diverticulum