female urology - urinary incontinence

Question 1

what are the main functions of the lower urinary tract ?

Answer 1

1. preservation of the upper tracts by low pressure storage of urine with continence and low pressure voiding to completion
2. storage
3. voiding

Question 2

how does storage of urine happen ?

Answer 2

by bladder relaxation

sphincter contraction

Question 3

how does voiding of urine happen ?

Answer 3

by bladder contraction

sphincter relaxation

Question 4

how does the filling phase occur ?

Answer 4

1. the bladder distends without rise in the intra-vesicle pressure
2. the sphincter unit contracts and closes the urethra

Question 5

how does the voiding phase happen ?

Answer 5

1. the bladder contracts and expels the urine

2. the sphincter unit relaxes and urethra opens

Question 6

which neural pathway is responsible for the filling phase?

Answer 6

sympathetic pathway

Question 7

which neural pathways responsible for the voiding phase?

Answer 7

parasympathetic pathway

Question 8

how does the sympathetic pathway work to allow for urine filling ?

Answer 8

noradrenaline works on b3 receptors which then allows for the relaxation of the detrusor muscle and the contraction of the urethral sphincter

Question 9

how does the parasympathetic pathway work to allow for the voiding of urine ?

Answer 9

acetylcholine works on muscarinic (M3) receptors and allows for the contraction of the detrusor muscle and the relaxation of the urethral sphincter

Question 10

what is the basic mechanism of urine incontinence ?

Answer 10

inappropriate bladder contraction
or
inappropriate sphincter relaxation

Question 11

if there is a problem with the sphincter function what is this type of incontinence called ?

Answer 11

stress incontinence

Question 12

if there is a problem with the bladder contraction what type of incontinence is this ?

Answer 12

urge incontinence

Question 13

what are the possible causes of urge incontinence ?

Answer 13

neurogenic
Multiple sclerosis
idiopathic
bladder pathology

Question 14

what are the possible causes of stress incontinence ?

Answer 14

1. weakness of pelvic floor as with women who have gone through multiple vaginal births
2. trauma - prostate surgery
3. neurological
   or involuntary leakage on effort such as with sneezing or laughing

Question 15

what does the abbreviation DIAPPERS stand for in history taking of urinary symptoms ?

Answer 15

delerium 
diuretics 
infection 
atrophy 
pharma 
psychological 
excess UO 
restricted mobility 
stool impaction

Question 16

how can stool impaction cause urinary incontinence ?

Answer 16

When hardened feces accumulates in the rectum, this can cause the anal sphincters to relax and allow liquid stool to escape around the blockage

Question 17

what examinations can be performed for a patient complaining of urinary symptoms ?

Answer 17

full bladder test - cystometric test
cough/valsalva
manual dexterity

Question 18

if a patient was to come complaining of urge incontinence what should the initial management be ?

Answer 18

1. behavioural therapy
   ( weight control, fluid control, caffeine intake)
2. continence advise
   ( training of pelvic floor muscles, bladder retaining)
3. pharmacotherapy

Question 19

what is the main goal of pharmacotherapy ?

Answer 19

achieve bladder relaxation

Question 20

what are the different types pf pharmaceutical drugs used to achieve bladder relaxation ?

Answer 20

b3 agonists 
M3 antagonists ( anti-muscarinic , anticholinergic)

Question 21

what kind of anti muscarinic drugs are used ?

Answer 21

tertiary amines such as :
solifenacin 
tolterodine 
or quaternary amines 
oxybutynin 
tricyclic antidepressants

Question 22

if the first line of treatment did not work what can be dpone ?

Answer 22

consider changing the type of anti-muscarinic
higher dose
combination treatment
mirabegron

Question 23

what can be used for overactive bladder syndrome ?

Answer 23

mirabegron

Question 24

what further management can be done in cases of urge incontinence in the failure of the pharmaceutical approach ?

Answer 24

Botox 
PTNS (percutaneous tibial nerve stimulation)
neuromodulation 
bladder augmentation
diversion

Question 25

if a patient comes complaining of stress incontinence what is the best initial management ?

Answer 25

manage the precipitating factors
weight optimization
pelvic floor exercises

Question 26

what further management could be done for stress incontinence ?

Answer 26

mid-urethral tape TVT/TOT
colposuspension
bulking agent
diversion

Question 27

what is the best management for mixed incontinence ?

Answer 27

treat the predominant symptom

Question 28

what is the best management for overflow incontinence ?

Answer 28

consider catheterization

Question 29

what is overflow incontinence ?

Answer 29

urge to urinate but only release a small volume