NG123 urinary incontinence questions

Question 1

Which patients with LUTS should have review by an MDT?

Answer 1

Pre surgery for women with stress incontinence, overactive bladder, primary prolapse (local MDT)
Repeat surgery for incontinence or prolapse (regional MDT)
Mesh is being considered for prolapse surgery (regional MDT)
Post-surgical mesh complications or symptoms (regional MDT)
Patients considering surgery who want children in the future (regional MDT)
The treatment being considered is not offered locally (regional MDT)
Patients with associated bowel symptoms (regional MDT)

Question 2

Which investigation should be performed for all patients presenting with LUTS?

Answer 2

All women presenting with LUTs should have a urine dip and be questioned for the symptoms of UTI

Question 3

Management for: Symptomatic of UTI, Leucocytes and nitrites present

Answer 3

Send MSU for MC+S , Treat with antibiotics straightaway

Question 4

Management for: Symptomatic of UTI, Negative for either leucocytes or nitrites

Answer 4

Send MSU and MC+S, Consider treating with antibiotics or wait for culture and sensitivities

Question 5

Management for: Asymptomatic of UTI , Leucocytes and nitrites present

Answer 5

Send MSU and MC+S Do not treat with antibiotics, wait for culture and sensitivities

Question 6

Management for: Asymptomatic of UTI, Negative for either leucocytes or nitrites

Answer 6

Do not sent MSU and MC+S , Do not treat with antibiotics

Question 7

When would a post void residual volume be appropriate as a first line investigation?

Answer 7

For women presenting with voiding symptoms e.g. hesitancy, slow stream, intermittency, terminal dribble
For women with recurrent UTI

Question 8

What other non-invasive investigation is recommended at first presentation with LUTS and who is it recommended for?

Answer 8

Bladder diary for minimum 3 days – records volume and type of fluids consumed, volume and frequency of urine passed, episodes of incontinence and associated activities or symptoms, night time urination

Recommended for any type of incontinence or overactive bladder symptoms

Question 9

Which non-invasive test is NOT recommended by NICE for routine investigation of incontinence?

Answer 9

Pad testing

Question 10

In a patient with stress incontinence, what would be an indication to perform urodynamic studies?

Answer 10

Mixed incontinence where either the predominant symptom is urge incontinence or the diagnosis is unclear
Presence of an anterior or apical prolapse
Presence of voiding symptoms
Previous surgery for stress incontinence

Question 11

Which patients do not need urodynamic studies prior to surgery for incontinence?

Answer 11

Patients with stress urinary incontinence

Patients with stress-predominant mixed urinary incontinence

Question 12

Which lifestyle modifications does NICE recommend for incontinence and OAB?

Answer 12

OAB – reduce caffeine intake, appropriate fluid intake, weight loss if >30 BMI

Incontinence – appropriate fluid intake, weight loss if >30 BMI

Question 13

What is the first line treatment for women with stress incontinence?

Answer 13

Supervised pelvic floor exercises for minimum 3 months consisting of 8 contractions 3 times per day

Question 14

When should electrostimulation and/or biofeedback be consideredfor women with stress incontinence?

Answer 14

It should not be offered routinely

Only offer to patients who cannot actively contract their pelvic floor muscles to aid motivation and adherence

Question 15

Who should bladder training be offered to?

Answer 15

Offer bladder training for 6 weeks for women with urgency or mixed urinary incontinence

Question 16

What are the benefits of a suprapubic catheter compared to a urethral catheter for long term catheterisation?

Answer 16

Reduced risk of symptomatic uti
Reduced risk of bypassing
Reduced risk of urethral complications

Question 17

When should drugs for OAB be reviewed?

Answer 17

4 weeks after initiation
Earlier than 4 weeks if adverse effects or poor tolerance of side effects
Once maintained on OAB drugs review should be yearly for under 65s and 6 monthly for over 65s

Question 18

If non-surgical methods haven’t worked, what is the first line surgical treatment for OAB and what investigation should be performed before surgery?

Answer 18

First line surgical treatment for OAB for when non-surgical treatments have failed or have not been tolerated = injections of botulinum toxin type A, starting with 100 units
Patients should be investigated for the presence of detrusor overactivity by cystometry before commencing treatment with injections of botulinum toxin type A

Question 19

Which surgical options are available for treatment of urinary stress incontinence?

Answer 19

Culposuspension
Autologous rectus fascial sling
Retro-pubic Mid- urethral mesh

Question 20

What other, less effective, surgical option is available to patients for urinary incontinence?

Answer 20

Injection of intramural bulking agents

Question 21

Which tests of urethral competence should not be used in patients presenting with incontinence?

Answer 21

Q-tip, Bonney, Marshall and Fluid-Bridge tests

Question 22

Which types of nerve stimulation are NOT recommended by NICE for treatment of OAB?

Answer 22

Transcutaneous sacral nerve and transcutaneous posterior tibial nerve stimulation

Question 23

What condition might percutaneous tibial nerve stimulation be used to treat and who is it appropriate for?

Answer 23

Treatment for overactive bladder for patients who have been reviewed by local MDT, surgical treatments have not worked or patient does not want botox

Question 24

How often should women using absorbent containment products be reviewed?

Answer 24

Yearly

Question 25

Which patients can bladder catheterisation be considered for?

Answer 25

Urinary retention is causing incontinence, symptomatic infections or renal dysfunction, and in whom
this cannot otherwise be corrected