Incontinence

Question 1

What is the #1 test for SUI?

Answer 1

cough stress test

Question 2

What are the 3 causes of SUI?

Answer 2

1) loss of intrabdominal urethra
2) Loss of UV angle
3) Hypermobility of the urethra (qtip >30 deg)

Question 3

RF for incontinence

Answer 3

Female
obesity
Parity
Smoking
Age
Cognitive/mobility impairment

Question 4

What are the phases of micturition?

Answer 4

Storage phase (Bladder filling, first sensation to void)
Emptying phase (normal desire to void)

Question 5

Detrusor contraction is mediated by

Answer 5

Parasympathetic nerves (S2-S4), mediated by Ach acting on muscarinic receptors

Question 6

Urethral sphincter is mediated by

Answer 6

Proximal urethra - contracts via sympathetic stimulation (T11-L2) (smooth muscle)
Distal urethra - contracts via cholinergic somatic stimulation (S2-S4) (striated muscle)

Proximal-symp-smooth
Distal-chol-striated

Question 7

4 types of incontinence

Answer 7

Urge (20%)
Stress (50%)
Mixed (30%)
Overflow

Question 8

Physiology of filling/storage

Answer 8

Inhibition of parasympathetics
Stimulation of sympathetics
alpha-contraction
beta-relaxation

Question 9

Physiology of voiding

Answer 9

Stimulation of parasympathetics
Inhibition of sympathetics
Inhibition of somatic nerves to striated urogenital sphincter

Question 10

Reversible causes of incontinence

Answer 10

DIAPPERS
Delerium
Infection
Atrophy
Pharmacy
Psychological
Excessive fluid intake
Restricted mobility
Stool impaction

Question 11

Conservative management of OAB

Answer 11

Timed voiding - begin with q 30-60 mins; gradually increase q 1-2 weeks until q3-4 hr interval
Behavioural - wt loss, smoking cessation, caffein, timed voids, weekly PT

Question 12

Pharm management of OAB

Answer 12

Anticholinergic drugs

• oxybutinin (Ditropan)
• tolterodine (Detrol)
• Solifenacin (Vesicare)

Question 13

How do the anticholinergic drugs work in OAB?

Answer 13

block PSNS Ach pathways wihch control detrusor contractions and result in its relaxation

Question 14

Side effects and C/I of anticholinergics

Answer 14

S/E - dry mouth, headache, constipation

C/I - narrow-angle glaucoma, junctional arrhythmia, GI/GU obstruction

Question 15

Surgical management of OAB

Answer 15

Sacral neuromodulation

Question 16

Surgical management of SUI

Answer 16

3 categories:

• Retropubic urethropexy (Burch, MMK)
• Pubovaginal sling (Traditional slings, Midurethral sling-TVT, TOT)
• Periurethral bulking agents

Question 17

Difference between burch and MMK?

Answer 17

Burch - Attach paravaginal tissue to coopers ligament

MMK - Attache paravaginal tissue to pubic bone