Geriatrics

Question 1

5 types urinary incontinence and broad causes

Answer 1

1. Urge incontinence (bladder factors eg OAB)
2. Stress incontinence (urethral factors,with rise intra abdominal pressure )
3. Overflow incontinence (fail to empty-chronic retention. Bladder or urethra)
4. Total incontinence (urethral factors )
5. Other eg fistula, ectopic ureter, diverticulum

Question 2

Define stress incontinence

Answer 2

Leakage of urine from URETHRA with rise in abdominal pressure eg cough, strain, in the absence of a detrusor contraction
Most common, 60-70%

Question 3

Define urge incontinence

Answer 3

Inability to suppress reflex bladder contractions

30% of incontinence

Question 4

Most common type incontinence?

Answer 4

Stress

Question 5

Define overflow incontinence

Answer 5

Continuous dribbling incontinence with high residual volume (Full bladder usually due to retention)

Question 6

Medical treatment of urge incontinence

Answer 6

Muscarinic Anticholinergic drugs: oxybutinin, tolterodine

Question 7

Medical treat of stress incontinence (2)

Answer 7

• Increase bladder outlet resistance: alpha adrenergic agonists eg pseudoephedrine
Serotonin/noradrenaline reuptake inhibitor - duloxetine (SNRI)
• increase urethral resistance (females) - HRT. Vaginal oestrogens

Question 8

Surgical treatment of stress incontinence (5)

Answer 8

Anterior colporrhaphy (Vaginal wall repair )
Burch Colposuspension (female)
Tension-free Vaginal Tape (tvt) or transobturator tape (tot)
Periurethral bulking injection (Teflon)
Artificial urinary sphincter ( post prostatectomy incontinence)