Female Urinary Incontinence

Question 1

What is the bladder nerve supply?

Answer 1

Storage - hypogastric nerve
Voiding - pelvic nerve (parasympathetic)
Voluntary - pudendal nerve

Question 2

Describe cortical activity on bladder filling

Answer 2

Activates sympathetic pathway and reciprocal inhibition of parasympathetic
Mediates contraction of bladder base and proximal urethra

Question 3

What is cortical influence on bladder emptying?

Answer 3

Activation of parasympathetic pathway and inhibition of sympathetic pathway

Question 4

What are the different types of urinary incontinence?

Answer 4

Any involuntary leakage of urine
Stress - on effort or exertion
Urge - accompanied or preceded by urgency
Mixed - combination of all

Question 5

What are the risk factors for urinary incontinence?

Answer 5

Age, parity, menopause, smoking, medical problems, increased abdo pressure, pelvic floor trauma, denervation, connective tissue disease and surgery

Question 6

What is the main risk factor for urinary incontinence?

Answer 6

Pregnancy and childbirth

Question 7

What are some irritation symptoms?

Answer 7

Urgency, increased daytime frequency, nocturia, dysuria and hamaturia

Question 8

What are some incontinence symptoms?

Answer 8

Stress, urgency, coital incontinence and severity - pads a day

Question 9

What is assessed in a patient presenting with urinary incontinence?

Answer 9

Irritancy and incontinence symptoms
Voiding symptoms
Fluid intake
Effect on QoL
Prolapse and bowel symptoms

Question 10

What urinary tests are done for incontinence?

Answer 10

3 day urinary diary
Urine dipstick

Question 11

What examinations are done for women with bladder/ pelvic floor problems?

Answer 11

General, abdominal, neurological, gynaecological and pelvic floor assessment

Question 12

What invetsigations are done for urinary incontinence?

Answer 12

Urinalysis - multistix and possible MSSU
Post voiding residual volume assessment
Urodynamics - only if surgery indicated

Question 13

What are the types of management for urinary incontinence?

Answer 13

Lifestyle changes, medical treatments, physiotherapy and surgery

Question 14

Describe stress urinary incontinence

Answer 14

Intra-abdominal pressure exceeds urethral pressure
Pressure is increased by pelvic floor muscle training, surgery and pharmacological agents

Question 15

What are the lifestyle changes for urinary incontinence?

Answer 15

Stop smoking, lose weight, eat more healthy to avoid constipation and stop drinking alcohol and caffeine

Question 16

What is pelvic floor muscle training more effective than?

Answer 16

Than no treatment, electrical stimulation and vaginal cones
60-70% cure/ significant improvement

Question 17

What pharmacological agent is used for moderate to severe stress urinary incontinence?

Answer 17

Yentreve - Duloxetine
Restricted use

Question 18

Who should receive Duloxetine?

Answer 18

Primary care - if PFMT has failed or will be advanced with it
Secondary - do not wish surgery or not fit, failed surgery and when patient’s family is not complete

Question 19

What is the anatomical defect in stress and urge incontinence?

Answer 19

Arises from defect in the anterior vaginal wall and pubo-urethral ligament

Question 20

What is the integral theory of female UI?

Answer 20

Anatomical defect in anterior vaginal wall and pubo-urethral ligament in stress and urge
Sub-urethral hammock laxity might result in stimulation of bladder neck stretch receptors - premature micturation reflex

Question 21

Describe mid-urethral slings and retro-pubic TVT

Answer 21

Tension free vaginal tape (TVT) - minimally invasive procedure to reinforce structures supporting the urethra
80% cure at 11 year follow up
Polypropylene permanent synthetic tape

Question 22

Describe TVT vs colposuspesion

Answer 22

TVT is as effective as colposuspension for treatment of primary USI up to 2 years
Less operative and postoperative morbidity

Question 23

What are the complications for TVT?

Answer 23

Bladder perforation
Vaginal and urethral erosions
Vascular injuries

Question 24

Describe overactive bladder syndrome

Answer 24

Symptom complex usually but not always related to urodynamically demonstrable detrusor overactivity

Question 25

What are the defining symptoms for overactive bladder syndrome?

Answer 25

Urgency (with or without urgency incontinence), usually with frequency and nocturia

Question 26

What are the risk factors for urge incontinence?

Answer 26

Advanced age, diabetes, UTIs and smoking
OAB is chronic condition therefore symptoms may wax and wane

Question 27

Describe the prevalence of OAB syndrome

Answer 27

Increases with age in males and females
Over 60 - higher in men
Under 60 - higher in females

Question 28

What is the management for OAB?

Answer 28

Treat symptoms, no immediate care, MDT and requires dedicated approach

Question 29

What lifestyle interventions can be done for OAB?

Answer 29

Normalise fluid intake, reduce caffeine, fizzy drinks, chocolate, stops smoking and weight loss

Question 30

What is bladder training programme?

Answer 30

Times voiding with gradually increasing intervals - continence nurse

Question 31

What is the pharmacological treatment for OAB?

Answer 31

Antimuscarinic - oral (Solifenacin, fesoteridine, trospium chloride, darifencain, lyrinel and oxybutinin)
Transdermal - Kentera patched
Tri-cyclic antidepressants - imipramine

Question 32

What are recent advances in OAB treatment?

Answer 32

Botox and neuromodulation