Incontinence

Question 1

Incontinence definition

Answer 1

Inappropriate involuntary voiding of urine causes hygienic and social problems

Question 2

Name the types of incontinence

Answer 2

Stress incontinence Urge incontinence Overflow incontinence Total urinary incontinence

Question 3

Stress incontinence

Answer 3

Leakage of urine form the urethra with an increase in intraabdominal pressure in absence of a derisory contraction

Question 4

Urge incontinence

Answer 4

Inability to suppress reflex bladder contractions

Question 5

Total urinary incontinence

Answer 5

Continuous dribbling with low residual volume

Question 6

Filling and storage of urine needs?

Answer 6

Compliance Closed outlet Sensation of filling appropriately No involuntary derisory contraction

Question 7

The appropriate and voluntary voiding of urine requires

Answer 7

Cordinated detrusor contraction

Simultanous opening/relaxation of bladder outlet

No obstruction of bladder outlet

Question 8

Mechanisms to curb stress incontinence in women

Answer 8

Increased abdominal pressure is transmitted to the urethra and bladder

Question 9

Types of stress incontinence in women

Answer 9

Intrinsic urethral sphincter defiency

Urethra hypermobility

Question 10

Classification of urinary incontinece by causes

Answer 10

Failure to store

Failure to empty

Abnormal opening

Urethral diverticulum

Question 11

Bladder factors in failure to store incontinence

Answer 11

Involuntary contractions

detrusor instability

detrusor hyperreflexia

Question 12

Urethral factors in failure to store causes of incontinence

Answer 12

Anatomical stress incontinence (females)(urethral)

Post surgery (post prostectomy and post female incontinence surgery

After radiotherapy fr cervical therapy

After infiltration of external sphincter in BPH

Atrophic vaginitis

Neurological (sacral lesions and meningomyelocoele)

Question 13

Bladder factor s in failure to empty incontinence cause

Answer 13

Neurogenic LMN neuropathic bladder

Myogenic atonic detrusor

Drugs trycyclic antidepressants

Question 14

Urethral factors in failure to empty incontincence

Answer 14

Anatomic obstruction

• stricture
• bladder neck stenosis
• prostatic obstruction

Functional obstruction

• UMN neuropathic bladders where there is detrusor sphincter dysgernia contraction against closed external sphincter

Question 15

Abnormal openings in incontinence causes

Answer 15

Vesicovaginal fistula

Uretovaginal

Urththrovaginal

Ectopic ureter opening into vagiinaa for e.g

Question 16

Asepcts of detail of incontinence in history

Answer 16

Type

Precipitating factors

Severity

Bladder diary

Question 17

Past medical Hx

Answer 17

Neuro

Surgery

Parity

Drugs

Question 18

Causes of transient incontinence

Answer 18

DIAPPERS

delirium

infection

atrophic vaginitis

pharmaceuticals(diuretics)

psychological (depression)

excessive urine output( D)

Restricted mobility

Stool impaction

Question 19

Management of bladder factors

Answer 19

Medical

• anticholinergic drugs oxybutynin-ditropan, tolterodine-detrusitol

Surgical

• augmentation cystoplasty

Question 20

Management of urethral fx.

Answer 20

Increase bladder outlet resistance

medical

• alpha adrenergic agonists

Increase urethral resistance in females

Medical

• pelvic floor exercise and HRT

Surgical

• Tension free vaginal tape
• periurethal injection
• artificial urinary sphincter

Bypass urethra urinary diversion

Question 21

Management of bladder fx in failure to empty

Answer 21

Clean intermittent self catheterisation

Question 22

Mx of urthral fx. in failure to empty

Question 23

Management of abnormal openings

Answer 23

Surgical closure

Ureter implantation

Excision