Urinary Incontinence

Question 1

Frequency, small voided volumes
Urgency
Provocation
Key in the door
Sound of running water
Standing up
Coughing, laughing
Enuresis

Answer 1

Urge Urinary Incontinence

Question 2

Volume of urine produced in urge incontinence?

What may provoke the urge?

Answer 2

Small volume produced very frequently

Provocation: key in the door, sound of running water, standing up, coughing, laughing

Enuresis (wetting the bed at night)

Question 3

Treatment for urge incontinence

Answer 3

Dietary discretion (avoid caffeine)
Biofeedback
Bladder retraining, Time bladder emptying
Pharmacotherapy
Antimuscarinics - (e.g. oxybutynin, tolterodine)
Beta 3 adrenergics (mirabegron)
Botulinum toxin injection – unlicenced
Neuromodulation (“pacemaker” for the bladder)
Surgery
Enterocystoplasty

Question 4

What is urinary incontinence?

Answer 4

The complaint of any involuntary leakage of urine

Question 5

Name 2 ways in which urine may leak by an extraurethral route?

Answer 5

Extopic ureter

Fistula

Question 6

Which pressure is responsible for the voiding phase?

Answer 6

Detrusor pressure

Question 7

Where is the spinal bladder centre?

Answer 7

S2-S3

Question 8

Bladder outflow obstruction

Huge palpable bladder

Chronic retention

Insensible incontinence

Often wet at night

Renal impairment

Answer 8

Overflow incontinence

Question 9

Overflow incontinence

Answer 9

Bladder outflow obstruction

Huge palpable bladder

Chronic retention

Insensible incontinence

Often wet at night

Renal impairment

Question 10

Which type of drug may precipitate urge incontinence?

Answer 10

Diuretics

Question 11

How would you diagnose detrusor overactivity?

Answer 11

Urodynamics

Question 12

What is detrusor overactivity?

Answer 12

Bladder dysfunction characterised by detrusor contractions occurring during inhibition of voiding

Question 13

Causes of detrusor overactivity

Answer 13

Afferent overstimulation (e.g. due to irritation in the bladder)

Excess central facilitation

Paraplegia

Destruction of S2-S3 centre

Pelvic surgery/fracture (parasympathetic nerves damaged)

Idiopathic detrusor overactivity

Question 14

What is (urodynamic) stress incontinence

Answer 14

Urine leaks during increased intra abdominal pressure, without a detrusor contraction

Question 15

Detrusor contraction in (urodynamic) stress incontinence?

Answer 15

No

Question 16

What causes (urodynamic) stress incontinence?

Answer 16

Damage to the pelvic floor or urethral function

e.g. child birth

Question 17

How to diagnose (urodynamic) stress incontinence?

Answer 17

Urodynamics

Question 18

There is someone with a distended tummy, how do you know its the bladder?

Answer 18

Painless palpable mass arising from the pelvis
Cannot “get below it”
Dull to percussion

Question 19

Treatment for overflow incontinence

Answer 19

Assess renal function
Treat the obstruction
Catheterise
rehabilitate the bladder
Teach intermittent self catheterisation

Question 20

Treatment for urge urinary incontinence

Answer 20

Dietary discretion (avoid caffeine)
Biofeedback
Bladder retraining, Time bladder emptying
Pharmacotherapy
Antimuscarinics - (e.g. oxybutynin, tolterodine)
Beta 3 adrenergics (mirabegron)
Botulinum toxin injection – (was unlisenced, one now liscenced)
Neuromodulation (“pacemaker” for the bladder)
Surgery
Enterocystoplasty

Question 21

Antimuscarinics you could use in urge urinary incontinence?

Answer 21

Oxybutynin

Tolterodine

Question 22

What are oxybutynin and tolterodine?

Answer 22

Anti-muscarinics

Question 23

Name a beta 3 adrenergic you could use in urge urinary incontinence?

Answer 23

Mirabegron

Question 24

What is mirabegron?

Answer 24

A beta-3 adrenergic (you coud use this in urge urinary incontinence)

Question 25

Surgery you might carry out in urge incontinence (very last choice)

Answer 25

Enterocystoplasty (allows the bladder to hold more urine)

Question 26

What is duloxetine?

Answer 26

Serotonin 5-HT

Question 27

Treatment for stress incontinece

Answer 27

Weight loss Stop smoking! Pelvic floor exercises - physiotherapy Pharmacotherapy – (not very much role) ``` Duloxetine (serotonin (5-HT) and norepinephrine (NE) reuptake inhibitor) Surgical correction Open procedures – colposuspension largely replaced by: Minimally invasive “tape” procedures ```

Question 28

What is colposuspension?

Answer 28

Putting stitches in to support the neck of the bladder -very last surgery option for stress incontinence (now been replaced by "tape" procedures)

Question 29

Which non-urethral cause of urinary incontinence should you be aware of in developing countries?

Answer 29

Vesico-vaginal fistula -this is because they have prolonged obstructed labour

Question 30

Voiding symptoms

Answer 30

Slow stream Splitting/spraying of the urinary stream Hesitancy Straining

Question 31

What does a frequency volume chart record?

Answer 31

Records the volumes voided as well as the time of micturition, day and night for at least 24 hours

Question 32

What is urinary incontinence?

Answer 32

Urinary incontinence is the complaint of any involuntary leakage of urine.

Question 33

What is stress urinary incontinence?

Answer 33

Stress urinary incontinence is involuntary leakage on effort or exertion, or on sneezing or coughing.

Question 34

What is urgency urinary incontinence?

Answer 34

Urgency urinary incontinence is involuntary leakage accompanied by, or immediately preceded by urgency

Question 35

What is urgency?

Answer 35

Urgency is the complaint of a sudden compelling desire to pass urine, which is difficult to defer

Question 36

What is over active bladder syndrome/urge syndrome/urgency-frequency syndrome?

Answer 36

Urgency, with or without urge incontinence, usually with frequency and nocturia, can be described as overactive bladder syndrome, urge syndrome or urgency-frequency syndrome

Question 37

What is detrusor overactivity incontinence?

Answer 37

Detrusor overactivity incontinence is incontinence due to an involuntary detrusor contraction

Question 38

What is mixed urinary incontinence?

Answer 38

Mixed urinary incontinence is involuntary leakage associated with urgency and also with exertion- effort, sneezing or coughing.