urinary incontinence 3

Question 1

Neuromodulation

Answer 1

Tibial Nerve Stimulation

Sacral Nerve Stimulation

Question 2

BOTOX

Answer 2

 Botulinum toxin
 Injected into the bladder
 Relaxes the bladder
 Increase storage capacity
 Decreases incontinence
 Risk of retention

Question 3

Overflow Incontinence

Answer 3

 Pressure of urine in overfull bladder overcomes
sphincter control
 Leak small amounts frequently through day and night
 Urination may occur frequently in small amounts
 Bladder distended and palpable
 Causes: bladder outlet obstruction or deficient detrusor
contraction

Question 4

Bladder Outlet Obstruction

Answer 4

 Severe blockage
 Can’t evacuate contents 
despite detrusor contraction 
 Men: urethral stricture, 
enlarged prostate. 
 Women – POP

Question 5

Deficient Detrusor Contraction

Answer 5

 Muscle unable to contract 
with enough force to 
completely empty bladder
 Neurological diseases
 Diabetic neuropathy
 Overdistension
 Chronic alcoholism
 Medications

Question 6

Acute Urinary Retention

Answer 6

 Inability to empty bladder when person urinates
 Accumulation of urine in bladder as unable to urinate
 Acute urinary retention - total inability to pass urine
 Medical emergency!
 Needs bladder drainage with insertion of catheter

Question 7

Chronic Urinary Retention

Answer 7

 Incomplete bladder emptying despite urination
 Chronic over distension with large bladder capacity
 Diminished or delayed sensations of bladder filling
 Normal post-void residual (PVR) volumes 50 – 75ml
 Findings over 100ml show need to retest
 > 200mls on 2 separate occasions needs further evaluation

Question 8

Treatment Urinary Retention

Answer 8

Behavioural therapies – toilet schedules, 
double voiding
Vaginal Pessaries 
Urinary catheterisation
Pharmacology Therapies
Surgery – SNM, TURP, GLL, POP

Question 9

Pharmacology Interventions

Answer 9

BPH
 Tamsulosin (Flowmaxtra)
 Dutasteride (Avodart)
 Duodart - combination
POP
 Oestrogen cream
UAB
 Bethanechol

Question 10

Surgical Therapies

Answer 10

vTrans Urethral Resection Prostate
TURP
Green Light Laser
Anterior Vaginal Repair