Female urinary incontinence

Question 1

Upper urinary tract

Answer 1

kidney and ureter
low pressure distensible - intrinsic peristalsis
urine from nephrons to the ureters to bladder

Question 2

Lower urinary tract

Answer 2

bladder and urethra

low pressure storage of urine

Question 3

filling rate of bladder

Answer 3

0.5-5mls/min

Question 4

function of vesico-ureteric mechanism

Answer 4

protect nephrons from retrograde transmission of back pressure or infection from the bladder

Question 5

bladder nerve supply - storage

Answer 5

hypogastric T10-L2

sympathetic

Question 6

bladder nerve supply - voiding

Answer 6

pelvic nerve S2-4

parasympathetic

Question 7

bladder nerve supply - voluntary

Answer 7

pudendal nerve S2-4

somatic

Question 8

Cortical activity function - bladder filling

Answer 8

increase sphincter contraction and resistance

Question 9

how does cortical activity work in bladder filling

Answer 9

activate sympathetic pathway
reciprocal inhibition of the parasympathetic
contraction of bladder base and proximal urethra

Question 10

Bladder emptying

Answer 10

detrusor contraction
urethral relaxation
sphincter co-ordination
absence of obstruction

Question 11

Cortical influence in bladder emptying

Answer 11

pontine micturition centre

activate parasympathetic and inhibit sympathetic

Question 12

Urinary incontinence

Answer 12

Any involuntary leakage of urine

Question 13

stress UI

Answer 13

involuntary leakage on effort, sneezing, coughing etc

Question 14

urge UI

Answer 14

involuntary leakage accompanied or preceded by urgency

Question 15

Mixed UI

Answer 15

involuntary leakage accompanied or immediately preceded by urgency and on effort, sneezing etc

Question 16

Epidemiology of incontinence

Answer 16

10-25% of 15-60
15-40% of over 60
>50% in nursing homes

Question 17

Impact of UI

Answer 17

QOL 
sexual life 
social activities 
psychological 
self esteem

Question 18

Main risk factor for incontinence

Answer 18

parity and childbirth

Question 19

Other risk factors for incontinence

Answer 19

pelvic surgery 
age 
menopause 
smoking/alcohol 
medical 
increase intra abdominal pressure 
pelvic floor trauma
denervation 
connective tissue disease

Question 20

Incontinence - history

Answer 20

1. age, parity, mode of deliveries, weight of heaviest baby, smoking, HRT
2. medical conditions, DM, glaucoma, heart/kidney/liver
3. previous PFMT, surgical treatment of SUI or POP

Question 21

Irritation symptoms

Answer 21

urgency, >7 day, nocturia, dysuria, haematuria

Question 22

incontinence symptoms

Answer 22

SUI, UUI, coital, severity - number of pads

Question 23

Voiding symptoms

Answer 23

straining, interrupted flow, recurrent UTI

Question 24

Prolapse symptoms

Answer 24

vaginal lump, dragging sensation

Question 25

Bowel symptoms - incontinence

Answer 25

IBS, constipation, anal incontinence

Question 26

3 days urine diary

Answer 26

``` fluid intake - quantity and content urine output daytime frequency nocturia average voidal volume ```

Question 27

Examination

Answer 27

``` general eg BMI abdo - distention neurological - sacral lower limb gynaecological pelvic floor assessment prolapse SUI uro-genital atrophy pelvic mass pelvic floor, tone, strength, awareness ```

Question 28

Investigations

Answer 28

urinalysis post voiding residual volume urondynamics - uroflowmetry and cystometry

Question 29

4 broad management methods for incontinence

Answer 29

lifestyle changes surgery pharmacological physio

Question 30

How to increase urethral closure pressure in SUI

Answer 30

PFMT surgery pharmacology

Question 31

lifestyle changes

Answer 31

stop smoking lose weight eat healthy stop drinking alcohol

Question 32

PFMT - 3 basic principles of what it does

Answer 32

reinforce cortical awareness of muscle groups hypertrophy of existing muscle groups general increase in muscle tone and strength

Question 33

Pharmacological treatment for SUI

Answer 33

duloxetine

Question 34

Colposuspension

Answer 34

raise bladder neck - surgery

Question 35

Integral theory of female UI

Answer 35

both arise from problem with anterior vagina wall/pubo-urethral ligament USI - urethral/bladder neck closure dysfunction UUI - suburethral hammock laxity

Question 36

TVT function

Answer 36

reinforce structure supporting urethra

Question 37

First line for SUI surgery

Answer 37

TVT

Question 38

concerns over TVT

Answer 38

bladder perforation vaginal and urethral erosions several vascular injuries

Question 39

TOT side effect

Answer 39

thigh pain

Question 40

cause of OAB

Answer 40

detrusor overactivity

Question 41

OAB symptoms

Answer 41

urgency, frequency, nocturia, UUI

Question 42

urgency

Answer 42

complaint of sudden, compelling desire to pass urine

Question 43

OAB treatment

Answer 43

fluid intake, reduce caffeine, stop smoking, weight loss | bladder training programme

Question 44

Bladder retraining

Answer 44

re-establish cortical control over detrusor | timed bladder emptying programme

Question 45

pharmacological treatment of OAB

Answer 45

anti-muscarinic - oral or transdermal | tri cyclic antidepressants

Question 46

Recent advances in OAB treatment

Answer 46

botox | neuromodulation (S2-4)