Urinary incontinence and prolapse

Question 1

What is stress incontinence?

Answer 1

Leakage of urine during raised intraabdominal pressure

Question 2

What is overactive bladder?

Answer 2

Leakage associated with urgency, usually with detrusor muscle activity

Question 3

What might cause a fistula leading to incontinence?

Answer 3

Cervical cancer

Obstructive labour

Question 4

What are the symptoms of voiding difficulty?

Answer 4

Hesitancy

Poor stream

Incomplete emptying

Question 5

How is urinary incontinence investigated?

Answer 5

History

Examination

Urinalysis

Blood for renal function if suspect renal impairment

Bladder Chart

Pad test

Urodynamics

Others: electromyography, imaging renal tract, cystourethroscopy

Question 6

What does a bladder chart measure?

Answer 6

Voided volumes

Frequencies

UI episodes

Question 7

What does a pad test measure?

Answer 7

Quantified urine leakage over time

Question 8

What is encompassed in urodynamics?

Answer 8

Uroflowometry

Cystometry

Question 9

What does uroflowometry measure?

Answer 9

Flow rate: enables you to measure peak flow, mean flow and voided volume (minimum of 200mls void is required

Question 10

What is cystometry?

Answer 10

A method by which the pressure/volume relationship of the bladder is measured during filling, provocation and during voiding

Question 11

What diagnosis does the urodynamic chart show?

Answer 11

Stress urinary incontinence

Question 12

What diagnosis does the urodynamic chart show?

Answer 12

Bladder outflow obstruction

Question 13

What diagnosis does the urodynamic chart show?

Answer 13

Overactive bladder

Question 14

What are the conservative treatment options for stress incontinence?

Answer 14

Lifestyle: lose weight, stop smoking, reduce caffeinated drinks

Physiotherapy: pelvic floor muscle retraining, biofeedback, electrical stimulation, pessaries

Drugs: duloxetine

Incontinence pads

Vaginal pessaries

Question 15

What is duloxetine?

Answer 15

A combined noradrenaline and serotonin reuptake inhibitor (increase intraurethral closure pressure)

Question 16

What are the surgical options for stress incontinence?

Answer 16

Low tension vaginal tape

Intraurethral injection

Artificial sphincters

Colposuspension

Question 17

What is the low tension tape procedure?

Answer 17

A mesh tape is placed under the urethra like a sling

This keeps the urethra from sagging and keeps it closed when intra-abdominal pressure is raised

Question 18

What are the conservative treatment options for overactive bladder?

Answer 18

Lifestyle: avoid caffeine

Physiotherapy: bladder training

Drugs: antimuscarinic e.g. oxybutynin

Question 19

What surgical options are there for treatment of overactive bladder?

Answer 19

Botox injections

Sacral nerve modulation

Augmentation cystoplasty

Bladder overdistension

Question 20

In uterine prolapse, what are the degrees of uterine descent?

Answer 20

1st degree: in vagina

2nd degree: at interoitus

3rd degree: outside vagina

Procedentia: entirely outside vagina

Question 21

What types of pelvic organ prolapse are there?

Answer 21

Urethrocele

Cystocele

Rectocele

Enterocele

Uterus and cervix

Question 22

What is an enterocele?

Answer 22

Pouch of Douglas containing loops of small bowel prolapses into the vagina

Question 23

What are the symptoms of a cysto/urethrocele?

Answer 23

May be asymptomatic

Stress urinary incontinence

Urinary retention

Recurrent UTI

Question 24

What are the symptoms of a rectocele?

Answer 24

Dyschezia

Constipation

Question 25

What conservative management of prolapse is avaliable?

Answer 25

Reassure

Avoid heavy lifting, loose weight, stop smoking, reduce constipation

Vaginal oestrogens: only if symptomatic atrophic vaginitis

Physiotherapy