Urinary Incontinence

Question 1

Define incontinence

Answer 1

Complaint of any involuntary leakage of urine

Question 2

What pressures are present in the filling/storage phase?

Answer 2

Abdominal, intravesical, urethral, atmospheric

Question 3

What happens to the pressures in the voiding phase?

Answer 3

Urethra relaxes and detrusor pressure increases so pressure inside the bladder is greater

Question 4

Define compliance

Answer 4

The ability of the bladder to keep its pressure unchanged irrespective of volume and afferent stimulation

Question 5

What is the name of the device that measures urodynamics?

Answer 5

Cystomethogram

Question 6

Describe the micturition reflex

Answer 6

Afferent - pelvic parasympathetic nerves
Travel to S2-S3
Efferent - pudendal
There are also signals from the brain that facilitates and inhibits micturition

Question 7

State the four types of incontinence

Answer 7

• overflow
• urge
• stress
• mixed

Question 8

How does overflow incontinence present?

Answer 8

Huge palpable bladder, dull to percuss, chronic retention often with bed wetting. Due to bladder outflow obstruction and can cause renal impairment.

Question 9

How does urge incontinence present?

Answer 9

Daytime frequency, psychologically provoked by certain stimuli, enuresis and incontinence

Question 10

State the causes of urge incontinence

Answer 10

• source of bladder irritation (cystitis/stones/tumours)
• excess central facilitation (stress)
• paraplegia (loss of inhibition)
• destruction of S2-3 (loss of reflex)
• parasympathetic nerve damage in surgery/fracture leading to residual urine
• detrusor overactivity

Question 11

Describe stress incontinence

Answer 11

Urine leaks during increased intra-abdominal pressure without detrusor contraction due to damage to pelvic floor/urethral function often during childbirth

Question 12

How is overflow obstruction treated?

Answer 12

Catheterisation

Question 13

What lifestyle changes can help with urge incontinence?

Answer 13

Avoid caffeine, regular biofeedback (frequency volume charts, bladder retraining to time bladder emptying

Question 14

What pharmacological treatments can be used in urge incontinence?

Answer 14

Antimuscarinics (oxybutyuin, tolterodine)
Beta 3 adrenergics (mirabegron)
Botox injection to paralyse detrusor

Question 15

What surgical treatments can be used for urge incontinence?

Answer 15

Neuromodulation (pacemaker for bladder)

Surgical reconstruction

Question 16

How is stress incontinence treated?

Answer 16

Weight loss, stop smoking, physiotherapy
Duloxetine influence urethral tone
Surgical tape procedures

Question 17

Describe ectopic ureter

Answer 17

Rare and congenital condition. Wet all the time, ureter joins on the wrong side of sphincter

Question 18

What can occur post gynae surgery?

Answer 18

Vesico-vaginal fistula

Question 19

In developing countries what is a common cause of vesico-vaginal fistula?

Answer 19

Obstructed labour - baby’s head sits against the pubic tubercle with bladder in between leading to fistula formation