Exam 3: Female Urinary Incontinence

Question 1

Hypogastric innervation

Answer 1

Detrusor muscle

Question 2

Pudendal nerve innervation

Answer 2

External sphincter and pelvic floor

Question 3

Storage phase neurotransmitters

Answer 3

NE and 5HT
Detrusor relaxation
Sphincter contraction

Question 4

Emptying phase neurotransmitters

Answer 4

ACh

Detrusor contraction

Question 5

Stress incontinence

Answer 5

Involuntary leakage with increased pressure
Type 1: Absence of urethral hypermobility
Type 2: Due to hypermobility
Type 3: Intrinsic sphincter deficiency

Question 6

Urge incontinence

Answer 6

Leakage proceeded by massive urge
Overactive bladder
Neurogenic
Myogenic
Idiopathic

Question 7

Stress incontinence examples

Answer 7

Cough
Sneeze
Laugh
Exercise
Change position

Question 8

Urge incontinence examples

Answer 8

Urgency
Frequency
Nocturia
Dysuria

Question 9

Cystometry

Answer 9

Put volume in and assess patient feeling of fullness

Have them bear down etc

Question 10

Multi urochannel dynamics

Answer 10

Pressure monitor in urethra and rectum (damn near killed em)

Stress: narrow, tall peak
Urgency: wide, shorter peak

Question 11

Levator ani muscles

Fiber distribution

Answer 11

PPI
Puborectalis
Pubococcygeus
Iliococcygeus

70% type I
30% type II

Question 12

Pharm treatment

Answer 12

Anticholinergics
M1-5 in bladder
M2 predominance, but M3 mainly responsible for emptying
M1 -> dry mouth
M2 -> bradycardia

Question 13

Pharm examples

Answer 13

Oxybutinin (dry mouth, consipation, CI: acute, narrow angle glaucoma)
Tolterodine (receptor antagonist)
Trospium (quaternary ammonium non-receptor antagonist)