urinary incontinence and prolapse

Question 1

what is urinary incontinence ?

Answer 1

involuntary loss of urine

Question 2

what are the types of urinary incontinence ?

Answer 2

stress incontinence
urge incontinence
mixed incontinence
overflow retention

Question 3

where does the detrouser muscle get its nervous supply from ?

Answer 3

parasympathetic supply from S2,3,4

Question 4

which of the urethral sphincters are voluntary ?

Answer 4

the external urethral sphincter is voluntary

internal urethral sphincter is involuntary

Question 5

what does the pressure transmission theory explains ?

Answer 5

this explains that for continence to happen the intra-urethral pressure must remain higher than the intra-vesicle pressure

Question 6

what is stress incontinence ?

Answer 6

involuntary leakage on effort, exertion or any increase in intra-abdominal pressure

Question 7

what is the etiology behind stress incontinence ?

Answer 7

impaired urethral support

intrinsic sphincter deficiency

Question 8

what tests can be performed on examination of a patient complaining of incontinence ?

Answer 8

Q- tip test
Bonney’s test
Cough stress test

Question 9

what is the significance of the q-tip test ?

Answer 9

detect mobility of the urethro-vesical junction on straining

Question 10

what is bonney’s test ?

Answer 10

if there is vaginal and bladder neck descend this test temporarily corrects it to identify the problem

Question 11

what is urge incontinence ?

Answer 11

involuntary leakage accompanied by or immediately preceded by urgency

Question 12

what is the etiology behind urge incontinence ?

Answer 12

detrouser over-activity

Question 13

what is overflow incontinence ?

Answer 13

dribbling or continuous leakage associated with with incomplete bladder emptying due to impaired detrouser activity

Question 14

what is the aetiology behind overflow incontinence ?

Answer 14

detrouser under activity or obstruction

Question 15

what investigations can be performed for a patient complaining of incontinence ?

Answer 15

freq/voided volume chart 
urine tests (dipstick urinalysis)
urodynamic studies 
(cystometry, uroflometry)

Question 16

what is the pharmacological therapy for incontinence ?

Answer 16

anti-cholinergics / anti-muscarinics
mirabegron
solifenacin

Question 17

what would be the initial line of treatment for stress incontinence ?

Answer 17

weight control 
fluid intake control 
caffeine control 
pelvic floor exercises 
( Behavioural Therapy )

Question 18

what is the goal of surgical treatment in SUI ?

Answer 18

1. reposition the bladder neck to reduce and minimize hypermobility
2. improve the coaptation of the urethra so it cloases more effectivley

Question 19

what is the standard surgical treatment for SUI ?

Answer 19

Midurethral Sling ( TVT-TOT)

Question 20

what is pelvic organ prolapse ?

Answer 20

refers to the descend of one or multiple pelvic organs below their normal anatomical position

Question 21

what are the pelvic supports ?

Answer 21

endopelvic fascia
endopelvic ligaments
pelvic floor muscles ( levator ani)

Question 22

what are the types of prolapse ?

Answer 22

anterior compartment prolapse
posterior compartment prolapse
apical prolapse

Question 23

what are the types of uterine prolapse ?

Answer 23

1st degree to 3rd degree

4th degree is called procidentia

Question 24

what are the features of a first degree uterine prolapse ?

Answer 24

the cervix descends downward through the vagina but the external os does not reach the introitus

Question 25

what are the features of a second degree uterine prolapse ?

Answer 25

the external os reaches or slightly protrudes outside the introitus

Question 26

what are the features of a third degree uterine prolapse ?

Answer 26

the whole uterus except the fundus descends outside the introitus

Question 27

what are the features of 4th degree uterine prolapse or procidentia ?

Answer 27

the whole uterus including the fundus descends outside the introitus

Question 28

what are the symptoms of prolapse ?

Answer 28

mild cases are asymptomatic 
more severe cases :
pelvic heaviness 
sexual dysfunction 
rectal symptoms 
urinary symptoms 
a mass filling the vagina or protruding from the introitus

Question 29

what is important to exclude in the general examination ?

Answer 29

any cause for chronic increased intra-abdominal pressure

Question 30

how can prolapse be prevented ?

Answer 30

1. adequate spacing of deliveries to allow for proper involution
2. avoid marked obesity and rapid weight gain
3. avoid difficult and prolonged labour
4. proper episiotomy to avoid perineal damage
5. proper management of chronic cough or constipation n

Question 31

what are the non-surgical approaches of management in prolapse ?

Answer 31

pelvic floor exercises (Kegel exercises)

Pessary treatment which is only temporary until surgery can be performed

Question 32

what is the surgical management for prolapse ?

Answer 32

anterior colporrhaphy
posterior colporrhaphy
classic repair
abdominal hysterctomy and fascial repair

Question 33

what are the predisposing factors to prolapse ?

Answer 33

childbirth trauma
menopausal atrophy
congenital weakness
iatrogenic

Question 34

what factors precipitate prolapse ?

Answer 34

chronic increase in intrabdominal pressure :
heavy lifting
coughing
constipation

Question 35

what are the measurements that are used to quantify pelvic organ prolapse ?

Answer 35

1. position of distal anterior vaginal wall, proximal to the external urethral meatus
2. distal portion of the remaining anterior vaginal wall above point 1
3. the most distal edge of the cervix
4. the position of the posterior fornix
5. position of the distal posterior vaginal wall , proximal to hymen
6. most distal part of the posterior vaginal wall
7. the genital hiatus
8. the perineal body
9. the total vaginal length