Station 7

Question 1

Young Lady. Incontinence
Assess

Answer 1

History
Incontinence:
Timing - when it begun, ?worsening, Triggers (Stress versus Urge versus Both)
Severity - Pads? Wetness?
LUTS : Storage (FUN), Voiding (WISE)
UTI history

IMPACT ON QOL!!
Red Flags - Haematuria, Constant Leak (Fistula), Neurological Symptoms
Lifestyle - Fluid management (Type/Volume/Timing), Bowel Function, BMI

PMH - Obstetric/Gynae, Surgery, Radiotherapy, Urological Procedures, Comorbidities (Fitness)
DH - Allergies, Anticholinergics, Diuretics, HRT
SH - Smoking, Alcohol, Fitness, Activity Level

Question 2

Young Lady. Incontinence
Exam

Answer 2

General - BMI, Fitness,
Abdomen - Bladder/ Loin pain
Pelvic
- Prolapse, Precipitate leak with cough, Urethral Mobility
- Atrophic Vaginitis
- PF Muscle - Awareness and strength
- Palpable masses
- Speculum - Rectocele / Cystocele

Question 3

Young Lady. Incontinence
Investigate

Answer 3

Frequency Voiding Diary
ICIQ- UI ICIQ - OAB
Urinalysis - Cultures
FR + PVR
Pad Test

Imaging - If specific question. ?Loin Pain ?Deranged Renal Function Tests

Urodynamics - not entirely necessary however. If doubt about whether SUI or UUI. Before offering definitive surgical management

Question 4

How to perform 1 hour pad test?

Answer 4

Put on pad.
Drink 500 ml no salt fluid
Sit until 30 minutes
Various activities for 30 minutes
Weigh Pad. Void (measure volume)

> 1.4 grams (or 2 grams) considered significant.

Question 5

Mx of SUI

Answer 5

Conservative:
Lifestyle - weight loss, Smoking, increase exercise, fluid management
Pelvic Floor Muscle Training
Bladder Training (esp if concurrent OAB)

Medical:
Topical Oestrogens if vaginal atrophy
Duloxetine if not fit for surgery

Surgical:
Should have UDS and be discussed in PF MDT
All surgical options should be discussed with patient - temporary and definitive
Occlusive - Bulking, AUS
Supportive - Colopsuspension, Mid Urethral Sling
Catheter - Urethral/SPC
Urinary Diversion

Question 6

Consent for urethral bulking

Answer 6

Confirm patient details. Explain all options including doing nothing.

Common- Bleeding, Dysuria, Pain, Infection,
Failure, Recurrence/Further Procedures
Urinary Retentiion
Lower Urinary Tract Symptoms - Urgency, Voiding Symptoms
Reaction to bulking agent
Anaesthetic Risk

Question 7

Definition of:
i) UI
ii) SUI
iii)UUI
iv) MI
v) OAB

Answer 7

i) UI - Urinary Incontinence is the involuntary leakage of urine
ii) SUI - Stress UI is the involuntary leakage of urine in response to exertion
iii)UUI - Urge UI invluntary leakage of urine associated with urgency
iv) MI - Mixed I involuntary leakage of urien assocaited with urgency and exertion
v) OAB - with or without UI. urgency (sometimes freq and noct) in absence of other pathology