Urinary Incontinence

Question 1

What is meant by stress incontinence?

Answer 1

leakage on actions with raised pressure

e.g. sneezing or coughing

Question 2

What causes stress incontinence?

Answer 2

bladder neck/urethral hypermobility
OR neuromuscular defects
=> causing intrinsic sphincter deficiency

Question 3

What is urge incontinence?

Answer 3

leakage accompanied by or immediately preceded by urgency

Question 4

What causes urge incontinence?

Answer 4

Bladder overactivity (detrusor instability)

Pathology irritating the bladder (infection, tumour, stone)

Question 5

What does bed wetting in older men usually indicate?

Answer 5

High-pressure chronic retention

Question 6

Why does post-micturation dribbling usually occur?

Answer 6

Dribble immediately after leaving the toilet

Small amount of residual urine in prostatic urethra should go back up to bladder

Instead it collects in the bulbar urethra further forward

Question 7

What does a constant leakage of urine indicate?

Answer 7

FISTULA
Usually between bladder and vagina in females
- due to hysterectomy/ C-section

Question 8

In what circumstance would a young girl have a constant leakage of urine?

Answer 8

Ectopic ureter draining into the vagina/ proximal urethra

Question 9

What risk factors is it important to ask about in an incontinence consultation?

Answer 9

previous surgery
bowel symptoms
symptoms of sexual dysfunction
pelvic organ prolapse in women

Question 10

What red flag symptoms should you consider asking in an incontinence history

Answer 10

pain
haematuria
recurrent UTI
significant voiding/obstructive symptoms,
Hx of pelvic surgery/radiotherapy

Question 11

What should be included in a female pelvic examination?

Answer 11

• chaperone
• Ask Pt to cough/strain
  => look for vaginal wall prolapse and urinary leakage.

Internal examination to assess

• voluntary pelvic floor muscle strength
• bladder neck mobility

Inspect the vulva for vaginal atrophy (oestrogen deficiency)

Question 12

A palpable bladder full of urine on examination indicates what?

Answer 12

Patient is in retention

Question 13

How do patients construct a Bladder diary?

Answer 13

• Use a measuring jug to quantify the urine

- Write down what volume they passed and at what time of the day

Question 14

Females usually have higher flow rates than men. TRUE/FALSE?

Answer 14

TRUE

Question 15

Why is a two way catheter used in cystometry?

Answer 15

Allows on port for a water pump IN

and one port to measure bladder pressure

Question 16

What is meant by bladder training?

Answer 16

When needing to void, holding on for a bit of time to train the ability of the bladder to hold urine for longer before voiding

Question 17

What conservative treatments can be offered to help incontinence?

Answer 17

Pelvic floor exercises
Lifestyle modification
Medication – duloxetine
Electrical stimulation of pelvic floor

Question 18

What injection can be used to help with incontinence?

Answer 18

injection of bulking materials into bladder neck and periurethral muscles
=> increase outlet resistance

Question 19

Explain the aim of a retropubic suspension?

Answer 19

elevate and fix the bladder neck and proximal urethra in a retropubic position
=> support the bladder neck and regain continence

Question 20

What is meant by an overactive bladder?

Answer 20

urgency, with or without urge incontinence
plus frequency and nocturia

caused by bladder (detrusor) overactivity

Question 21

What conservative treatments are recommended for an overactive bladder

Answer 21

Pelvic floor exercises
Bladder training
Behavioural modification
avoid stimulants (caffeine, alcohol)

Question 22

What anticholinergic/antimuscarinic medications can inhibit contractions and increase bladder capacity in an overactive bladder?

Answer 22

Oxybutynin
Solifenacin
Tolterodine

Question 23

What drug class is Mirabegron and how does it help in an overactive bladder?

Answer 23

β3-AR agonists

=> increase bladder capacity with no change in micturition pressure and the residual volume

Question 24

If conventional therapies for an overactive bladder are unsuccessful, what other therapies can be tried?

Answer 24

Intravesical Botox A
Neuromodulation
Augmentation “Clam” ileocystoplasty
Ileal conduit urinary diversion

Question 25

Where is intravesical Botox A injected?

Answer 25

20 sites under bladder mucosa or into detrusor (sparing the trigone)

Question 26

What is the purpose of a neuromodulation device?

Answer 26

sacral nerve stimulation

=> suppresses involuntary bladder contraction reflex

Question 27

Describe what is meant by an Ileal conduit urinary diversion?

Answer 27

both ureters anastomosed
connected to a short length of ileum
Ileum brought out cutaneously as stoma (urostomy)