urinary incontinence

Question 1

what is urge urinary incontinence

Answer 1

leakage accompanied by or immediately preceded by urgency

Question 2

what can cause urge urinary incontinence

Answer 2

bladder overactivity

Question 3

what does bed wetting in elderly men usually indicate

Answer 3

high pressure chronic retention

Question 4

what causes post-micturition dribble in men

Answer 4

urine pooling in bulbar urethra

Question 5

what does a constant leak of urine suggest

Answer 5

a fistulous communication between the bladder and vagina

Question 6

what anatomical disorders can cause urinary incontinence

Answer 6

• vesicovaginal fistula
• ectopic ureter in girls
• urethral diverticulum
• urethral fistula
• bladder extrophy
• epispadias

Question 7

red flags for urinary incontinence

Answer 7

• pain
• haematuria
• recurrent UTI
• significant voiding/obstructive symptoms
• history of pelvic surgery/radiotherapy

Question 8

investigations for urinary incontinence

Answer 8

• bladder diary
• urinalysis +/- culture
• flow rate and post-void residue
• pad testing

Question 9

conservative treatment for urinary incontinence

Answer 9

• pelvic floor exercises
• lifestyle modifications
• medication (duloxetine)

Question 10

what is injection therapy for urinary incontinence

Answer 10

the injection of bulking materials into the bladder neck and periurethral muscles to increase outlet resistance

Question 11

main indication for injection therapy

Answer 11

female stress incontinence secondary to demonstrable intrinsic sphincter deficiency in the presence of normal bladder function

Question 12

contraindications for injection therapy

Answer 12

• UTI
• untreated bladder overactivity
• bladder neck stenosis

Question 13

what is retropubic suspension used to treat

Answer 13

female stress incontinence predominantly caused by urethral hypermobility

Question 14

what is the aim of a retropubic suspension

Answer 14

to elevate and fix the bladder neck and proximal urethra in a retropubic position in order to support the bladder neck and regain continence

Question 15

what happens in burch colposuspension

Answer 15

vaginal wall is elevated and attached to the lateral pelvic wall

Question 16

complications of suburethral tapes and slings

Answer 16

• voiding dysfunction
• vaginal, urethral and bladder perforation
• pain
• damage to bowel or blood vessels

Question 17

what is an artificial urinary sphincter

Answer 17

Question 18

what is an artificial urinary sphincter used for

Answer 18

moderate to severe SUI secondary to urethral sphincter deficiency in patients with normal bladders

Question 19

what is overactive bladder (OAB)

Answer 19

a symptom syndrome that includes urgency, frequency and nocturia

Question 20

treatment for OAB

Answer 20

• pelvic floor exercises
• biofeedback
• acupuncture
• electrical stimulation therapy
• behavioural modification

Question 21

how does acetylcholine cause bladder overactivity

Answer 21

acts on muscarinic receptors on the bladder smooth muscle to cause involuntary contractions

Question 22

name some anticholinergic drugs

Answer 22

Oxybutynin
Solifenacin
Tolterodine
Fesoterodine
Trospium
Propiverine

Question 23

contraindications for anticholinergic meds

Answer 23

uncontrolled narrow-angle glaucoma, myasthenia gravis, BOO, bowel disorders

Question 24

side effects of anticholinergics

Answer 24

dry mouth, constipation, blurred vision, urinary retention, cognitive impairment

Question 25

what do beta-adrenoceptor agonists do to the bladder

Answer 25

increase bladder capacity with no change in micturition pressure and the residual volume

Question 26

if all conventional therapy for OAB doesn’t work what is the next option

Answer 26

intravesical botulinum toxin-A injected into bladder

Question 27

what is neuromodulation

Answer 27

sacral nerve stimulation involves electrical stimulation of the bladder’s nerve supply to suppress reflexes responsible for involuntary detrusor contrcation