Gynaecology: Urogynae

Question 1

What test can differentiate between overactive (urge) and stress incontinence?

Answer 1

Urodynamics

Question 2

What is the difference between overactive, stress and overflow incontinence?

Answer 2

Stress - weak pelvic floor or sphincter muscles causes leakage during increased intra-abdominal pressure such as coughing, sneezing

Overactive (urge) - increased activity of detrusor muscles preceded by strong desire to pass urine

Overflow - Bladder detrusor muscles becomes enlarged and flacid, causes leakage if bladder over-fills

Question 3

What is the treatment for stress incontinence

Answer 3

1. Pelvic floor/kegel exercises
   - x8 a day for 3 months
2. Duloxetine - SNRI
3. Surgery - tension free vaginal tape

Question 4

What is the treatment for urge (overactive) incontinence?

Answer 4

1. Bladder re-training
2. Oxybutynin (anti-cholinergic)
3. Botulinum toxin A or neuromodulation and sacral N stimulation

Question 5

How long must medical management for incontinence be used for?

Answer 5

at least 4 weeks

Question 6

What are the side effects of oxybutynin and Duloxetine?

Answer 6

Both have anti-cholinergic side effects

• dry mouth
• urinary retention
• constipation
• blurred vision

Question 7

What is the treatment for prolapse?

Answer 7

1. Reduce weight < 30 BMI
2. Pelvic floor exercises
3. Pessary - ring, shelf or gel horn