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WACS > URINARY INCONTINENCE > Flashcards

URINARY INCONTINENCE Flashcards

1
Q

Define urinary incontinence

A

Involuntary leakage of urine that is a social and
hygienic problem and is objectively
demonstrable

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2
Q

What is the prevalence of urinary incontinence

A

25%

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3
Q

3 types of urinary incontinence

A

Stress
Urge
Mixed

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4
Q

% of stress incontinence

A

49%

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5
Q

% of urge incontinence

A

29%

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6
Q

% of mixed incontinence

A

22%

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7
Q

4 areas of interest in the physical examination for urinary incontinence

A

Atrophy
Prolapse
Pelvic floor strength
Focused neurological
assessment

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8
Q

2 investigations for urinary incontinence

A

urine microscopy and culture
post void residual volume

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9
Q

What is the scale for assessing pelvic floor strength

A

Oxford scale

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10
Q

From the oxford scale, pelvic floor exercises should be done with a score of

A

3 or more

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11
Q

A score of 2 or less in the oxford scale will require these 3 interventions

A

electrical stimulation, biofeedback or vaginal cones

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12
Q

0 in the oxford scale means

A

No response

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13
Q

1 in the oxford scale means

A

Flicker

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14
Q

2 in the oxford scale

A

Weak contraction

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15
Q

3 in the oxford scale signifies

A

Moderate contraction, degree of lift

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16
Q

4 in the oxford scale signifies

A

Good contraction and can squeeze muscle against some
resistance

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17
Q

5 in the oxford scale signifies

A

Normal contraction, strong squeeze and lift against
resistance

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18
Q

To rule out reversible causes of urinary incontinence use the – assessment

A

DIPPERS assessment

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19
Q

Components of the DIPPERS assessment

A

D - Delirium
I - Infection
P - Pharmaceuticals
P - Psychological morbidity
E - Excess fluid intake
R - Restricted mobility
S - Stool impaction

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20
Q

At what post void residual volume do you refer to a urologist

A

> 50ml

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21
Q

T/F: The post void residual volume for the 3 types of incontinence is < 50ml

A

T

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22
Q

In what type of incontinence is nocturia seen

A

Urge and mixed incontinence

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23
Q

T/F: Small volume leakage of urine (5-10ml) is seen on voiding diary with stress incontinence

A

T

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24
Q

T/F: Variable volume loss on voiding diary with urge and mixed incontinence

A

T

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25
Q

3 parameters to look out in the intake portion of the voiding diary

A

Quantity, quality and timing

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26
Q

Parameters to look out for the output portion of the voiding diary

A

Quantity
Frequency D/N
Urgency
Incontinence
QOL
Pads, etc

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27
Q

T/F: The pad test objectively quantifies leakage

A

T

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28
Q

The 2 types of pad test

A

1 hour
24 hours

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29
Q

Weight for the 1 hr pad test

A

< 1g

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30
Q

Weight for the 24hr pad test

A

< 5g

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31
Q

The QOL questionnaire is the —

A

King’s Health Questionnaire

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32
Q

What scores are possible in the king’s health questionnaire

A

0 - 100

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33
Q

T/F: Increasing score in the king’s health questionnaire
represents worsening QoL

A

T

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34
Q

T/F: Urodynamics includes all measurements that assess the function and dysfunction of the LUT by any appropriate method, including cystometry and pressure-flow studies

A

T

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35
Q

4 basic requirements for urodynamics include:

A
  1. Representative uroflowmetry
    with post-void residual (PVR)
  2. Transurethral cystometry
  3. Pressure-flow studies
  4. Urethral pressure profilometry
    (UPP): Not part of Standars
    Urodynamics
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36
Q

5 reasons for doing urodynamics

A
  1. To identify the factors contributing to the incontinence and their relative importance
  2. Obtain information about other aspects of upper and lower urinary tract dysfunction.
  3. To predict the outcome including undesirable
    side-effects of a contemplated treatment
  4. To understand the reason for failure of previous treatments for incontinence or to confirm the
    effects of treatment
  5. Part of surveillance or research programs
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37
Q

5 indications for urodynamics

A
  1. Mixed incontinence
  2. After failed conservative measures
  3. Before and after experimental treatment
  4. LUT suggestive of neurological involvement
  5. In those with substantial risk of renal complications
    (e.g. spina bifida, spinal cord injury or anorectal
    abnormalities)
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38
Q

When is urodynamics not recommended by NICE

A

if pure SUI has been diagnosed
based on history and examination, unless there is a suggestion of
voiding dysfunction, anterior compartment prolapse or previous
surgical management

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39
Q

Conservative management for stress leakage involves – and –

A

Pelvic floor exercises ±
duloxetine for stress
leakage

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40
Q

Conservative management for overactive bladder symptoms

A

Bladder retraining ±
anticholinergics

41
Q

T/F: UTI invalidates results of urodynamic studies

A

T

42
Q

In urodynamic studies, iatrogenic UTI occurs what % of cases

A

5 - 10%

43
Q

The 3 positions for urodynamic studies

A

Standing, sitting and squatting

44
Q

What is urodynamic stress incontinence

A

A condition in which there is involuntary loss of urine when intra-vesical pressure exceeds
maximum urethral closure pressure in the absence of detrusor activity

45
Q

What maintains urethral competence

A

Anterior vaginal wall support
- Bladder neck and midurethral support

Functioning levator ani and external urethral sphincter (voluntary)

Functioning internal sphincter (involuntary)

46
Q

Damage to endopelvic fascia results in –

A

Loss of support

47
Q

Damage to levator ani results in – and –

A

Loss of support and occlusive pressure

48
Q

Damage to the nerves will result in – and –

A

Loss of support and occlusive pressure

49
Q

Improvement and cure rate with pelvic floor exercises

A

17 - 79%

50
Q

Cure/improvement rate with duloxetine

A

50% reduction in incontinence episodes in 50%

51
Q

% of patients experiencing nausea with duloxetine

A

23%

52
Q

When is surgery done for urodynamic stress incontinence

A

After failure of conservative measures

After urodynamics

53
Q

3 surgical mechanisms for correcting urodynamic stress incontinence

A

§ Bladder neck elevation (colposuspension)
§ Midurethral support (midurethral tape)
§ Urethral compression (bladder neck injection)

54
Q

The most effective surgical
procedure for stress incontinence

A

Burch colposuspension

55
Q

What is the continence rate with Burch colposuspension at 1yr, 5yrs and 12yrs

A

85 -90% at 1yr
70% at 5yrs
69% at 12yrs

56
Q

T/F: Colposuspension is an abdominal procedure, corrects cystocele and elevates bladder neck

A

T

57
Q

5 complications of colposuspension

A

10% voiding dysfunction
17% detrusor overactivity
Urinary tract injury
14% Subsequent prolapse
Major surgery

58
Q

Retropubic midurethral tape also known as

A

TVT: Tension-free vaginal tape

59
Q

What is the 7yr cure rate of TVT

A

81%

60
Q

T/F: Postoperative catheterisation not routine for TVT

A

T

61
Q

How many incisions are required for TVT

A

2 suprapubic incisions and 1 midurethral incision

62
Q

Anaesthesia for TVT

A

IV sedation and local anaesthesia

63
Q

7 complications of TVT

A

Bladder injury
Retropubic haematoma
Nerve, bowel and vascular injury
UTI
Voiding difficulty
Detrusor overactivity
Erosion

64
Q

% objective cure rate of TVT and colposuspension at 6 months

A

approx 72%

65
Q

% objective cure rate of TVT and colposuspension at 2 years

A

approx 80%

66
Q

How many incisions are required for the TOT technique

A

1 midurethral and 2 thigh fold incisions

67
Q

T/F: Cystoscopy and postoperative catheterisation not
routine for TOT

A

T

68
Q

T/F: Other suburethral tapes are fascia lata and rectus sheath

A

T

69
Q

3 synthetic preparations used for periurethral injections

A

Bovine collagen
Porcine collagen
Silicone

70
Q

Cure rate for periurethral injection

A

48% cure rate at 1 year (worsens with time)

71
Q

T/F: Repeat injections often necessary with periurethral injections

A

T

72
Q

7 injectable implants

A
  1. Collagen
  2. Silicone Microparticles
  3. Carbon Beads (Durasphere)
  4. Polytetrafluoroethylene Paste
    (PTFE, Teflon, Urethrin)
  5. Autologous Fat
  6. Autologous Chondrocytes
  7. Calcium Hydroxyl Apatite
73
Q

Define detrusor overactivity

A

A condition in which the detrusor is objectively shown to contract either spontaneously, or on
provocation, during bladder filling while the subject is trying to inhibit micturition

74
Q

4 symptoms of detrusor overactivity

A

Frequency, urgency, nocturia and urge incontinence

75
Q

T/F: With bladder retraining initial interval between voids guided by urinary diary

A

T

76
Q

T/F: Bladder retraining should be combined with pelvic floor exercises

A

T

77
Q

How long does it take to see improvement with bladder retraining

A

2 to 3 weeks

78
Q

T/F: With bladder retraining 75% of patients reduce no. of incontinence episodes by 50%

A

T

79
Q

5 examples of antimuscarinics

A

Oxybutynin
Tolterodine
Trospium chloride
Solifenacin
Transdermal oxybutinin

80
Q

% efficacy of antimuscarinics

A

25 - 50%

81
Q

5 side effects of antimuscarinics

A

Dry mouth
Blurred vision
Tachycardia
Drowsiness
Constipation

82
Q

Bladder-selective, long-acting, (od) antagonist.

A

Solifenacin

83
Q

T/F: Solifenacin has same efficacy as Long-release tolteridine but
?better with Incontinence Episode Frequency (IEF)

A

T

84
Q

Highly selective M3 receptor antagonist

A

Darifenacin

85
Q

T/F: Darifenacin is effective in reducing number, amplitude, and
duration of overactive bladder contractions

A

T

86
Q

Darifenacin reduces weekly incontinence episodes by – %

A

77%

87
Q

First in class beta 3 adrenoceptor agonist

A

Mirabegron (Betmiga)

88
Q

What is the mechanism of action of Mirabegron

A

Agonises ß3 receptors on the bladder leading to detrusor mm relaxation

89
Q

T/F: Mirabegron has minimal intrinsic activity on ß1 and ß2

A

T

90
Q

3 adverse effects of Mirabegron

A

Hypertension, UTI, nasopharyngitis

91
Q

T/F: Botulinum toxin is currently licenced for incontinence

A

F

92
Q

Mode of administration of the botulinum toxin

A

Intravesical administration to inhibit release of acetylcholine

93
Q

% improvement with botulinum toxin administration

A

70%

94
Q

Where are electrodes implanted for sacral nerve stimulation

A

S3/4

95
Q

With sacral nerve stimulation major clinical benefit is seen in up to –%

A

83%

96
Q

4 complications of sacral nerve stimulation

A

Pain at the electrode and
neurostimulator site
§ Change in bowel function
§ Technical problems
§ Infection

97
Q

T/F: Clam cystoplasty has cure rates up to 90%

A

T

98
Q

With repeated treatment failures for incontinence what do you do?

A
  1. Urologist:
    - Artificial sphincters
    - Urinary diversion
  2. Supportive therapy
    - Supplying incontinence aids
    pads etc
    - Catheterisation
    - Housing

WACS (19 decks)

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