Urinary incontinence

Question 1

Define incontinence

Answer 1

involuntary loss of urine or stool in sufficient amount or frequency to constitute a social and/or health problem

Question 2

Is urinary incontinence a part of normal aging?

Answer 2

no

Question 3

What are the sections of the male urethra?

Answer 3

prostatic urethra
membranous urethra
bulbous urethra
penile urethra

Question 4

Name some types of incontinence

Answer 4

urgency incontinence
stress incontinence
overflow incontinence/nocturnal enuresis
continuous incontinence
post-micturition dribbling

Question 5

Define urge incontinence

Answer 5

involuntary leakage of urine accompanied or immediately preceded by urgency

Question 6

What is urinary urgency?

Answer 6

sudden compelling desire to void which is difficult to defer for fear of leakage

Question 7

Define stress urinary incontinence

Answer 7

involuntary leakage on effort, exertion, sneezing or coughing

Question 8

What causes stress incontinence?

Answer 8

damage to continence mechanism

men = TURP, RRP, trauma
women = ligament, fascia laxity

Question 9

What causes continuous incontinence?

Answer 9

sphincter incompetence
fistula

Question 10

Describe giggle incontinence

Answer 10

young women/children
involuntary loss of urine during laughing

Question 11

What causes post void dribbling?

Answer 11

urine can pool in bulbous urethra

Question 12

Risk factors for incontinence

Answer 12

female
older age
parity
pregnancy
obesity

(in men - prostatectomy, bladder outlet obstruction)

Question 13

Name some storage symptoms that should be asked in an incontinence history

Answer 13

frequency day and night
longest postpone
urgency
leakage

Question 14

Name some voiding symptoms that should be asked in an incontinence history

Answer 14

hesitancy
poor stream
incomplete emptying

Question 15

Incontinence red flags

Answer 15

history of UTI
frank haematuria
pain
pelvic mass
pelvic radiation
previous surgery
symptomatic prolapse
suspected fistula

Question 16

What investigations should be done in urinary incontinence?

Answer 16

dipstick
voiding diary
flow rate and post void residual
questionnaires
urodynamics

Question 17

Urge incontinence due to detrusor overactivity treatment

Answer 17

conservative - fluid and dietary advice, bladder retraining
antimuscarinics
S3 neuromodulation
surgery - botox, S3 implant, clam cystoplasty

Question 18

How do antimuscarinic drugs work in urge incontinence?

Answer 18

inhibit muscarinic receptors in bladder
decreases involuntary detrusor contractions and increases bladder capacity

Question 19

Name some antimuscarinic drugs used in urge incontinence

Answer 19

oxybutynin
tolterodine
trospium

Question 20

Contraindications to anticholinergics

Answer 20

uncontrolled narrow angle glaucoma
myasthenia gravis
bowel disorders eg. UC, bowel obstruction

Question 21

Side effects of antimuscarinic drugs

Answer 21

dry mouth
constipation
raised IOP
blurred vision
paralysis of accommodation
drowsiness
confusion
tachycardia

Question 22

Mirabegron MOA

Answer 22

selective B3 adrenoceptor agonist
relaxes detrusor muscle during storage phase
improves storage capacity and decreases voiding frequency

Question 23

Treatment for female stress urinary incontinence

Answer 23

conservative - weight loss, pfmt (pelvic floor muscle training)

drugs - duloxetine

surgery - injectables, sling surgery, colposuspension

Question 24

Male stress urinary incontinence treatment

Answer 24

pelvic floor muscle training
injectables
male sling
artificial urinary sphincter