Urinary incontinence

Question 1

What is urinary incontinence?

Answer 1

The involuntary leakage of urine

Question 2

What are the two main types of urinary incontinence?

Answer 2

Stress incontinence
Urge incontinence
Mixed

Question 3

Describe stress incontinence

Answer 3

Involuntary leakage of urine during increased intra-abdominal pressure - in the absence of a detrusor contraction

Question 4

When is stress incontinence commonly seen?

Answer 4

After childbirth
Oestrogen defiency states
Pelvic surgery
Pelvic irradiation

Question 5

What is the mechanism behind stress incontinence?

Answer 5

Pelvic floor denervation

Question 6

Describe urge incontinence

Answer 6

Prescence of urgency, usually with frequency and nocturia in the abscence of UTI or other obvious pathology

Question 7

What is urge incontinence otherwise known as?

Answer 7

Overactive bladder syndrome

Question 8

List some causes of urge incontinence

Answer 8

Multiple scelrosis
Spina bifida
Idiopathic
Pelvic/incontinence surgery

Question 9

What investigation is used to detect over-activity of detrusor muscle in urge incontinence?

Answer 9

Urodynamic testing

Question 10

Describe overflow incontinence

Answer 10

Leakage of urine from a full urinary bladder, often in the absence of any urge to urinate

Question 11

What is a bladder fistula?

Answer 11

Opening between the bladder and another organ - vagina or rectum

Question 12

What is an urethral diverticulum

Answer 12

Outpocketing of the urethra into the anterior vaginal wall

Question 13

What is functional incontinence?

Answer 13

Physical or mental barriers that prevent the patient reaching the toilet

Question 14

What is temporary incontinence

Answer 14

Due to reversible factors such as constipation and UTI

Question 15

What are the clinical features of stress incontinence

Answer 15

Leakage on coughing, sneezing exercise

Leakage volume is often small and coincides with physical stress

Question 16

What may be seen on examination in someone with stress incontinence?

Answer 16

Prolapse of the urethra and anterior vaginal wall

Asking a patient to cough with a semi-full bladder may demonstrate the incontinence

Question 17

What are the clinical features from history of a person with urge incontinence?

Answer 17

Urgency
Frequency
Nocturia
Trigger factors - running water, cold weather
Large volumes of leakage compared to stress incontinence

Question 18

Which type of incontinence results in larger volumes leaked?

Answer 18

Urge incontinence

Question 19

What is urgency?

Answer 19

A sudden and compelling desire to pass urine which is difficult to defer

Question 20

What is Nocturia?

Answer 20

Having to wake one or more times during the night to pass urine

Question 21

What is day time frequency

Answer 21

A perception of voiding urine too often during the day

Question 22

What must you rule out in a patient presenting with urinary incontinence?

Answer 22

UTI

Question 23

How are urge and stress incontinence investigated?

Answer 23

Frequency/volume charts

Urodynamic studies

Question 24

What is seen on frequency/volume charts in stress incontinence?

Answer 24

Normal frequency and bladder capacity

Question 25

What is seen on frequency/volume charts in urge incontinence?

Answer 25

Increased frequency

Question 26

What are urodynamic studies useful for?

Answer 26

Performed in stress urinary incontinence when considering surgery to confirm diagnosis and rule out concomitant detrusor over-activity

Question 27

Describe the conservative management of stress urinary incontinence

Answer 27

Lifestyle changes - weight loss and smoking cessation

Treatments of risk factors - such as chronic cough/other conditions which raise the intrabdominal pressure

Supervised pelvic floor muscle training - 3 months at least

Question 28

Describe the surgical management of stress urinary incontinence

Answer 28

Tension free vaginal tape - Most commonly performed operation with high cure rate

Burch colposuspension/Laparoscopic colposuspension - rarely performed

Peri-urethral injection - older patients not suitable for surgery

Transobturator mid-urethral slings

Question 29

Describe a tension free vaginal tape

Answer 29

Involves a tape being placed under the mid urethra via a small vaginal incision

Question 30

Which complication of tension free vaginal tape is causing the most controversy at the moment?

Answer 30

Erosions into the vagina, urethra and bladder resulting in chronic pain

Question 31

Describe the medical management of stress incontinence

Answer 31

Duloxetine - after surgical intervention or for women who surgery is not appropriate

Question 32

Describe the conservative management of urge incontinence

Answer 32

Lifestyle changes - fluid intake and aversion to caffeine and diuretics

Bladder retraining

Question 33

Describe the medical management of urge incontinence

Answer 33

Anticholinergic medication

Intravaginal oestrogens

Botulinum toxin A

Neuromodulation and sacral nerve stimulation

Question 34

List some anticholinergic medications used to treat urge incontinence

Answer 34

Oxybutynin
Solifenacin
Tolterodine

Question 35

What are some side effects of anticholinergic medication?

Answer 35

Xerophthalmia, xerostomia, constipation, blurred vision, arrhythmias, confusion

Question 36

What are the contraindications to anticholinergic medication?

Answer 36

Acute angle closure gluacoma
Myasthenia gravis
GI obstruction

Question 37

Describe the surgical management of urge incontinence

Answer 37

Detrusor myomectomy and augmentation cytoplasty

Question 38

When is surgical management used for urge incontinence?

Answer 38

As a last resort only