Urinary incontinence and pelvic organ prolapse

Question 1

What are the different forms of urinary incontinence?

Answer 1

Stress
Mixed
Urge/ overactive bladder

Question 2

Why should a dipstick be undertaken in all women with urinary incontinence?

Answer 2

Detect; 
Blood
Glucose
Protein 
Leukocytes
Nitrites

Question 3

How long should a bladder diary be taken for?

Answer 3

3 days covering variations in usual activities such as both working and leisure days

Question 4

What are the lifestyle interventions for urinary incontinence?

Answer 4

Trial of caffeine reduction to women with overactive bladder
Modify fluid intake; ensure around 2L a day
If BMI over 30; advise weight loss

Question 5

For how long should pelvic floor muscle training last?

Answer 5

At least 3 months as a 1st line for women with stress of mixed
At least 8 contractions 3 times a day

Question 6

For what group of women should electrical stimulation +/- biofeedback be considered?

Answer 6

Women who cannot actively contract pelvic floor to aid motivation and adherence to therapy

Question 7

Who should bladder training be offered to?

Answer 7

Minimum of 6 weeks as 1st line for women with urgency or mixed

Question 8

When can percutaneous posterior tibial nerve stimulation be offered?

Answer 8

Local MDT review
Non-surgical management including overactive bladder medicine has not worked
Woman does not want botulinum toxin or percutaneous sacral nerve stimulation

Question 9

When should bladder catheterisation be considered?

Answer 9

Persistent urinary retention is causing incontinence, symptomatic infections or renal dysfunction and in whom this cannot be otherwise correted

Question 10

What should be taken into consideration when prescribing an anticholinergic medicine?

Answer 10

Coexisting conditions (poor bladder emptying, cognitive impairment, dementia)
Current use of other medicines that affect total anticholinergic load
Risk of adverse SE; cognitive impairment

Question 11

When should desmopressin be considered?

Answer 11

In women to reduce nocturia

Use caution in women with CF and avoid in those over 65 with CV disease or hypertension

Question 12

What medication can be offered for stress incontinence?

Answer 12

Duloxetine

Question 13

What should be offered to treat women with overactive bladder with co-existing vaginal atrophy

Answer 13

Vaginal oestrogen

Question 14

When can botulinum toxin be offered?

Answer 14

After local MDT to women with an overactive bladder caused by detrusor overactivity that has not responded to non-surgical management including pharma tx

Question 15

What are the options for surgical management of stress urinary incontinence?

Answer 15

Colposuspension
Autologous rectus fascial sling
Retropubic mid-urethral mesh sling
Intramural bulking agents

Question 16

How are vaginal prolapses graded?

Answer 16

POP-Q system; assess and record presence and degree of prolapse of anterior, central and posterior vaginal compartments of vaginal wall

Question 17

What should be examined in women presenting with vaginal prolapse?

Answer 17

POP-Q
Activity of pelvic floor muscles
Vaginal atrophy
Rule out pelvic mass

Question 18

What history should be taken from women presenting with prolapse?

Answer 18

Symptoms of prolapse
Urinary function
Bowel function
Sexual function

Question 19

What are the lifestyle modifications for vaginal prolapse?

Answer 19

Losing weight if BMI over 30
Minimising heavy lifting
Preventing or treating constipation

Question 20

When should topical oestrogen be utilised in vaginal prolapse?

Answer 20

If signs of vaginal atrophy

Question 21

In what women can pelvic floor muscle training be helpful in vaginal prolapse?

Answer 21

At least 16 weeks in women with symptomatic POP-Q stage 1 or 2

Question 22

When should pessaries be considered in vaginal prolapse?

Answer 22

Women with symptomatic pelvic organ prolapse

Question 23

What should be discussed before pessary treatment?

Answer 23

Treat vaginal atrophy with oestrogen
More than 1 pessary fitting may be required to find a suitable one
Can affect sexual interocourse
Complications

Question 24

What are the complications of a pessary?

Answer 24

Vaginal discharge
Bleeding
Difficulty removing pessary
Pessary expulsion

Question 25

How often should a pessary be removed?

Answer 25

At least once every 6 months

Question 26

What are the surgical options for women with uterine prolapse?

Answer 26

Hysterectomy
Vaginal sacrospinous fixation
Manchester repair
Sacrocolpopexy