Urinary Incontinence

Question 1

What are risk factors for urinary incontinence?

Answer 1

1. Age
2. Immobility
3. CI
4. Diabetes
5. UTI
6. Neurological disease

Question 2

What are the three main types of UI? What are less common causes?

Answer 2

1. Urge: sudden desire to void just before
2. Stress: exertion, sneeze or cough
3. Mixed

Less Common
1. Overflow
2. Functional (psych or mobility)
3. Radiotherapy
4. Post micturition dribble
5. Total incontinence

Question 3

What is overactive bladder?

Answer 3

Urgency with or without incontinence
More with age
Similar in men and women

Question 4

What are age related changes to the urinary tract?

Answer 4

1. Decreased bladder capacity
2. Decreased sensation of filling
3. Increased detrusor overactivity
4. Decreased contractile function
5. Increased residual urine
6. Decreased closure pressure in F
7. Enlarged prostate in males
8. Decreased estrogen = atrophy

Question 5

What medical comorbidities are associated with UI?

Answer 5

1. T2DM
2. Degenerative joint disease, immobility
3. COPD
4. CHF
5. OSA
6. Constipation
7. Stroke
8. Parkinson’s
9. Dementia
10. Depression

Question 6

What medications can contribute to UI?

Answer 6

Alpha blockers in F
ACEi (cough)
Anticholinergics
CCB
CHei
Diuretics
Opioids
Sedative, hypnotics, antipsychotics
SSRIs
SGLT2i
Gabapentin

Question 7

What PVR is abnormal?

Answer 7

<100 normal
Up to 200 acceptable
>200 inadequate emptying
>300 suggests retention
>400 retention

Question 8

What are non-pharmacologic tx for urinary incontinence?

Answer 8

1. Avoid caffeine
2. Bladder training
3. Prompted voiding
4. Timed voiding/prompted voiding
5. Weight loss
6. Manage constipation
7. Dec cough and smoking
8. Functional training/exercise
9. Pelvic floor training
10. Pessary
11. Reduce fluids if over hydrating/adequate fluid intake

Question 9

What investigations should you do for urinary incontinence?

Answer 9

Post void bladder scan
Vaginal exam
Urinalysis
Urodynamics only in F with refractory or complicated symptoms
Cystoscopy only in F with complicated UI or gross hematuria

Question 10

What are the pharmacologic treatments for UI, side effects and CI?

Answer 10

1. Mirabegron (B3 adrenoreceptor agonist): sfx: HTN, UTI, nasopharyngitis, CI: hypersensitivity, sev uncontrolled HTN
2. Oxybutynin (worst for cognition), tolterodine, fesoteradine, solifenacin, darifenacin (antimuscarinics): sfx: anticholinergic CI: gastric retention, untx narrow angle glaucoma
3. Topical estrogen - vaginal sx, reduce risk recurrent UTI
4. Duloxetine (SNRI) - for stress UI

Question 11

How to treat BPH?

Answer 11

Alpha blocker (terazosin, doxazosin, tamsulosin)
5 alpha reductase (finasteride, dutasteride)

Question 12

What are options for surgical management in UI?

Answer 12

Effective for stress UI
Most effective and durable approach
Midurethral sling

Question 13

What effect does UI have on QOL?

Answer 13

1. Falls
2. Decreased mobility
3. Caregiver burden
4. Anxiety/depression
5. Hygiene problems
6. economic burden of incontinence products
7. Institutionalization

Question 14

What is the MOA of mirabegron?

Answer 14

Beta 3 adrenoreceptor agonist
Binds to receptor = relax detrusor = inc bladder capacity

Question 15

What defines a UTI?

Answer 15

Dysuria or fever/chills/confusion
PLUS
1 new or worsening genitourinary symptom (urgency, frequency, incontinence)

Question 16

What is the mechanism of action of antimuscarinics in UI?

Answer 16

Bind to muscarinic receptor
Block Ach from attaching to it
Reduce smooth muscle contraction of bladder

Question 17

What invasive intervention options are there for UI?

Answer 17

1. Botulinum injection to detrusor
2. Percutaneous tibial nerve stimulation
3. Transcutaneous tibial nerve stimulation
4. Sacral neuromodulation