Retention and Incontinence

Question 1

define acute urinary retention

Answer 1

a medical emergency characterised by an abrupt development of inability to pass urine over many hours

Question 2

risk factors of acute urinary retention

Answer 2

> 50 yrs
male sex
MH of BPH

Question 3

clinical features of acute urinary retention

Answer 3

complete inability to urinate despite urge
abdominal/pelvic pain
bladder distension

Question 4

investigations of acute urinary retention

Answer 4

bladder US
CT pelvis
bloods (FBC, U+Es, PSA and glucose)

Question 5

management of acute urinary retention

Answer 5

immediate catheterisation

treatment of underlying trigger

Question 6

define chronic urinary retention

Answer 6

an incomplete emptying of the bladder, occurring over a prolonged time period

Question 7

common causes of chronic urinary retention

Answer 7

BPH
prostate cancer
pharmacological causes
congenital conditions

Question 8

risk factors of chronic urinary retention

Answer 8

male sex
age >50yrs
increased age
use of H1 receptor antagonists

Question 9

clinical features of chronic urinary retention

Answer 9

urinary frequency 
weak/interrupted stream 
nocturia 
abdominal swelling + discomfort 
urgency but no voiding

Question 10

investigations of chronic urinary retention

Answer 10

post-void residual measurement
renal tract US
cystoscopy

Question 11

management of chronic urinary retention

Answer 11

intermittent or long-term catheter

urostomy

Question 12

complications of chronic urinary retention

Answer 12

post-obstructive diuresis
CKD
hydronephrosis

Question 13

define stress incontinence

Answer 13

leakage of the urine during times of increased abdominal pressure (e.g. laughing, coughing or squatting)

Question 14

risk factors of stress incontinence

Answer 14

childbirth (especially vaginal)

hysterectomy

Question 15

define urge incontinence

Answer 15

the sudden and involuntary loss of urine accompanied by extreme urgency

Question 16

risk factors of urge incontinence

Answer 16

recurrent UTIs 
high BMI 
advancing age 
smoking 
caffeine

Question 17

define overflow incontinence

Answer 17

a condition which causes leakage of urine without warning

Question 18

causes of overflow incontinence

Answer 18

underactivity of detrusor muscle due to neurological damage or due to constipation or prostatism

Question 19

define functional incontinence

Answer 19

involves the individual having the urge to pass urine but are unable to due to lacking necessary access

Question 20

causes of functional incontinence

Answer 20

sedating medications
alcohol
dementias

Question 21

conservative management of stress incontinence

Answer 21

avoiding caffeine, sugary drinks and excess fluid intake

pelvic floor exercises

Question 22

medical management of stress incontinence

Answer 22

duloxetine but only if conservative measurements fail

Question 23

surgical management of stress incontinence

Answer 23

incontinence pessaries
bulking agent placement
colposuspension

Question 24

gold standard management of stress incontinence

Answer 24

mid-urethral slings

Question 25

conservative management of urge incontinence

Answer 25

bladder diary
avoiding caffeine, fizzy drinks and excess fluids
pelvic floor exercises

Question 26

medical management of urge incontinence

Answer 26

anticholinergic medication (e.g. oxybutynin, tolterodine and fesoterodine)
bladder instillation
sacral neuromodulation