Urinary Incontinence

Question 1

what is definition of urinary incontinence

Answer 1

complaint of any involuntary leakage of urine

Question 2

what are the types of urethral incontinence

Answer 2

Overflow incontinence
Urge incontinence
Stress incontinence
Mixed incontinence

Question 3

what can cause urine to leak extraurethral

Answer 3

ectopic ureter

fistula

Question 4

what happens in the storage phase

Answer 4

Intravesical pressure is less than the urethral pressure

Urine stays in bladder

Question 5

what can affect urethral pressure

Answer 5

abdominal pressure

Question 6

what happens in the voiding phase

Answer 6

active contraction of the detrusor muscle - increases intravesical pressure
exceeds urethral pressure
flow occurs

co-ordinate relaxation of the bladder outlet

Question 7

what spinal level is the bladder centre

Answer 7

S2-S3

Question 8

what nerves play a part in the reflex arcs of the bladder

Answer 8

pelvic parasympathetic nerves

pudendal nerve

Question 9

what are features of overflow incontinence

Answer 9

Huge palpable bladder
Chronic retention
Insensible incontinence (no signal they are going to lose control)
Often wet at night

Question 10

what often causes outflow incontinence

Answer 10

bladder outflow obstruction

Question 11

what can be a consequence of continued bladder outflow obstruction

Answer 11

renal failure/impairment

Question 12

what is the features of urge syndrome

Answer 12

Frequency, small voided volumes
Urgency
- Provocation
Enuresis
Urge urinary incontinence (do not make it to the toilet on time)

Question 13

how is detrusor overactivity diagnosed

Answer 13

urodynamics

Question 14

what is detrusor overactivity

Answer 14

Bladder dysfunction characterised by detrusor contractions occurring during inhibition of voiding

Question 15

what can irritate the bladder and cause afferent overstimulation

Answer 15

bladder stone

bladder tumour

Question 16

what happens in paraplegia in relation to urinary incontinence

Answer 16

loss of central inhibition

Question 17

what spinal injury causes the bladder to become an inert bad

Answer 17

destruction around the lumbar region, S2 and S3

Question 18

what can damage the parasympathetic nerves around the bladder

Answer 18

pelvic surgery or fracture

Question 19

what is (Urodynamic) Stress incontinence

Answer 19

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

Question 20

causes of USI

Answer 20

damage to pelvic floor or urethral function - childbirth

Question 21

how is USI diagnosed

Answer 21

urodynamic diagnosis

Question 22

what would be seen on Examination of an overflow urinary incontinence

Answer 22

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

Question 23

Tx of overflow urinary incontinence

Answer 23

Assess renal function
Treat the obstruction
- Catheterise

Rehabilitate the bladder
- Teach intermittent self catheterisation

Question 24

Tx of urge urinary incontinence

Answer 24

Dietary discretion (avoid caffeine)
Bladder retraining,
Antimuscarinics - (e.g. oxybutynin, tolterodine)
Beta 3 adrenergics (mirabegron)
Neuromodulation (“pacemaker” for the bladder)
Surgery - Enterocystoplasty

Question 25

what is a Side effect of antimuscarinics

Answer 25

dry mouth

Question 26

Tx of stress incontinence

Answer 26

``` Stop smoking! Pelvic floor exercises - physiotherapy Weight loss Surgical correction - Open procedures – colposuspension - largely replaced by: Minimally invasive “tape” procedures ```

Question 27

what are the factors of urinary incontinence in the elderly

Answer 27

``` Immobility Dementia Drugs- diuretics, sedatives Obstruction and overflow Neuropathy Pelvic floor weakness ```

Question 28

what is a ectopic ureter

Answer 28

rare, congenital | ureter is joining with urethra below bladder

Question 29

when should ectopic ureter be considered

Answer 29

baby that cannot get out of nappies | child is developing normal but urine is leaking continuously

Question 30

what is vesico-veginal fistula

Answer 30

vagina and bladder touching causes ischaemia fistula is made urine leaks out seen in developing countries

Question 31

definition of stress urinary incontinence

Answer 31

involuntary leakage on | effort or exertion, or on sneezing or coughing

Question 32

definition of urgency

Answer 32

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

Question 33

definition of urgency urinary incontinence

Answer 33

involuntary leakage accompanied by, or immediately preceded by urgency.

Question 34

Urgency, with or without urge incontinence, usually with frequency and nocturia - what is this?

Answer 34

overactive bladder syndrome, or urge syndrome