Urinary Incontinence

Question 0

Each of the following is due to?

1. Genuine stress incontinence?
2. Urge incontinence?
3. Overflow incontinence?

Answer 0

1. Due to sudden increases in intra-abdominal pressure (in the absence of bladder muscle spasm)
2. Uninhibited and sudden bladder detrusor muscle contraction
3. Over distended, hypotonic bladder with absence of detrusor contractions

Question 1

Patient with genuine stress incontinence: physical exam findings? Best initial treatment?

Answer 1

1. Hypermobile urethra
2. Cystocele
3. Loss of ureterovesicular angle

Kegel exercises and timed voiding

Question 2

Cystometric evaluation?

Answer 2

Investigation of pressure and volume changes in the bladder with filling of unknown volumes

Question 3

Midurethral sling procedure?

Answer 3

Supporting midurethra with tensionless transvaginal tape or transobturator tape

Question 4

Transvaginal tape procedure used to fix? Type of technique?

Transibturator tape procedure?

Answer 4

Proximal urethra retropubic; blind technique to place synthetic tape under urethra

Originating laterally to avoid bladder/bowel injuries due to transvaginal tape procedure

Question 5

Normal effect of Valsalva on bladder/urethra?

Answer 5

Bladder and proximal urethra are normally intra-abdominal, so Valsalva increases pressure to BOTH the bladder and proximal urethra maintaining continence

Question 6

Pathophysiology genuine stress incontinence?

Answer 6

1. Trauma/Weakness of the pelvic diaphragm (childbearing)
2. Proximal urethra falls below the pelvic diaphragm
3. Increasing abdominal pressure (Valsalva/cough) now exerted on the bladder but not proximal urethra
4. Incontinence without urge to void

Question 7

Continue chapter 1

Answer 7

Continue