Pelvic Floor Disorders and Urinary Incontinence

Question 1

What causes overflow incontinence?

Answer 1

Underactive detrusor: neurologic, diabetes, multiple sclerosis
Obstruction: post-operative, severe prolapse (e.g. cystocele)

Question 2

Surgical options for stress incontinence

Answer 2

Urethral hypermobility: Mid-urethral sling, needle suspensions, anterior repair
Intrinsic sphincteric deficiency of urethra: Urethral bulking

Question 3

Where are cystoceles repaired?

Answer 3

Fix defects (tighten = plication) in pubocervical fascia or reattach to arcus tendineus fascia (sidewall/white line)

Question 4

Risk factors for pelvic organ prolapse

Answer 4

Age, parity, obesity, hysterectomy, chronic constipation, connective tissue disorders

Question 5

Treatments for pelvic organ prolapse

Answer 5

Weight loss, pelvic floor exercises, vaginal pessary, surgical repair

Question 6

How is urethral diverticulum diagnosed and treated?

Answer 6

MRI; surgical excision

Question 7

What kind of incontinence from atrophic vaginitis?

Answer 7

Urge

Decreased collagen, elasticity, and blood flow to trigone and urethra area
Decreased glycogen — decreased bacterial flora — higher pH — repeat UTI

Question 8

Chronic bladder pain syndrome - what? Treatment?

Answer 8

Interstitial cystitis - pain increases as bladder fills, decreases as it empties
No associated incontinence

Treat with bladder training, fluid management, amitriptyline, pentosan polysulfate sodium, other analgesics

Question 9

Stress vs urge vs overflow incontinence treatments

Answer 9

Stress - Kegel, mid-urethral sling

Urge (detrusor overactivity) - mirabegron (beta agonist) or muscarinic antagonist

Overflow (neurogenic bladder, detrusir underactivity) - suprapubic pressure, timed void, double voiding, intermittent self-catheterization