Female and Functional

Question 1

Incontinence Assessment

Answer 1

History
IQOL
Pad test
Examine
Urinalysis
Voiding Diary
FR + PVR

Question 2

Conservative Mx for Female Incontinence

Answer 2

Both:
Lifestyle, WL, Pads, Caffeine reduction, Topical Oestrogen, Desmopressin

UI - Bladder Training, Anti-Musc/Mirabegron, PTNS
SUI - PFMT, Bladder Training, Duloxetine (temporary improvement)

Question 3

Surgical Mx for SUI

Answer 3

Midurethral tape
Autologous Sling
Colpsuspension
Bulking Agent
Periurethral Compression balloon
Artifical urinary sphincter

Single incision Slings - Have been parked for now. Found to be inferior to MUS

Question 4

Female SUI Surgical Mx
Female UI Surgical Mx

Answer 4

SUI
1) Mid urethral sling/ Bulking
2) AFS / Colpsuspension / MUS

UI
1) Botox , SNS
2) Augmentation / Diversion

Question 5

Should you offer Bulking as a temporising measure before permanent continence surgery?

Answer 5

NO

Question 6

CI to Antimuscarinic Therapy

Answer 6

Poorly Controlled NA Glaucoma, Myaesthenia Gravis

Question 7

What were the results of Neptune Study

Answer 7

Neptune demonstrated that combining Solifenacing + Tamsulosin improved symptoms by 4 weeks in most men:
Prostate Vol < 75g
PVR < 150 ml

Incidence of AUR were in the region of 1%

Question 8

What were the resutls of the scorpio trial?
What is the CI of Mirabegron?

Answer 8

RCT
- Similar efficacy to tolterodine in improving Incontinence + Frequency

Mirabegron - CI in severe uncontrolled hypertension (Sys >180 mmHg)
- BP should be monitored regularly throughout treatment with mirabegron

Question 9

What were the findings of BESIDE trial

Answer 9

Combination therapy of Mirabegron + Solifenacin
- Reduced frequency + incontinence episodes compared to solifenacin alone.

Question 10

What were the findings of BESIDE trial

Answer 10

Combination therapy of Mirabegron + Solifenacin
- Reduced frequency + incontinence episodes compared to solifenacin alone.

Question 11

Intravesical Botox:
i) Rate of requiring CIC
ii) Reduction in rate of UI

Answer 11

i) 6.5% People Required CISC (~85% of these stopped using botox within 24 weeks)

ii) 50% Reduction in rate of UI

Question 12

Regimen for Vagifem

Answer 12

Every day for 2 weeks
Every other day for 2 weeks
2 times a week lifelong

Question 13

Which anticholinergic is suitable in the elderly?

Answer 13

Trospium Hydrochloride - Doesn’t cross the blood brain barrier