Renal Clinical Medicine Part 5: Approach to Urinary Incontinence (Miller)

Question 1

Transient urinary incontinence arises suddenly and lasts how long?

Is it reversible?

Answer 1

1) Less than 6 months

2) Yes

Question 2

Which chronic urinary incontinence is defined as leakage of urine with coughing, sneezing, or physical exertion?

Which sex is it more common in?

Answer 2

1) Stress UI

2) Women

Question 3

Which chronic urinary incontinence is defined as urine leakage with sudden compelling desire to void?

Which sex is it more common in?

Answer 3

1) Urge UI

2) Women and men

Question 4

Which chronic urinary incontinence is defined as urinary retention from detrusor underactivity or outflow obstruction?

Which sex is it more common in?

Answer 4

1) Overflow UI

2) Men

Question 5

What are specific risk factors for urinary incontinence in women?

In men?

Answer 5

1) Parity (especially vaginal deliveries) and menopause

2) Benign prostate hypertrophy

Question 6

What structures function to prevent urinary leakage and when they lose strength/function they lead to stress UI?

Answer 6

1) Pelvic floor musculature
2) External sphincter
3) Endopelvic fascia

Question 7

What structure when it involuntarily contracts leads to urge incontinence?

Answer 7

Detrusor muscle

Question 8

What is the most common cause of overflow incontinence?

Answer 8

Enlarged prostate (BPH)

Question 9

When performing a physical exam on a patient you suspect with UI, what should you include in the functional assessment?

Answer 9

1) Mental status
2) Mobility
3) BMI

Question 10

When performing a physical exam on a patient you suspect with UI, what can be performed for provocation?

Answer 10

Cough stress test

Question 11

In the evaluation of UI, the post-void residual volume test measures?

Answer 11

Completeness of emptying

Question 12

In the evaluation of UI, voiding diaries are a reliable tool which measure?

Answer 12

1) Micturition chart
2) Frequency-volume
3) 24 hour urine production

Question 13

What is valuable when incontinence diagnosis is uncertain after initial assessment, symptoms do not correlate with physical findings, or previous treatment failed?

When should this not be peformed?

Answer 13

1) Urodynamic studies

2) Initial workup

Question 14

What is characterized as cognitive, functional, or mobility difficulties that impair patients’ ability to use the toilet, but without a failure of bladder function or neurologic control of urination?

Answer 14

Functional UI

Question 15

Functional UI may be addressed by providing alternative receptacles such as?

Answer 15

Male urinal, commode, or condom catheter

Question 16

What is done for conservative management of stress UI?

Answer 16

Pelvic floor muscle strengthening (Kegel exercises)

Question 17

What are options for pharmacologic treatment of urge UI?

Answer 17

1) Antimuscarinics

2) Mirabegron (B1 adrenergic agonists)

Question 18

What is given for pharmacologic treatment of overflow UI?

Answer 18

Alpha-adrenergic antagonists

Question 19

What do the anticholinergic drugs act on when treating urge incontinence?

Answer 19

Detrusor muscle

Question 20

In the treatment of urge UI, intravesical onabotulinumtoxin A induces chemical neuromodulation at what site?

Answer 20

The detrusor presynaptic NM junction