Urinary Incontinence and Prolapse

Question 1

Define urinary incontinence

Answer 1

Involuntary loss of urine which can be objectively demonstrated and is a social or hygienic problem

Question 2

What are the main types

Answer 2

Stress - due to raised intra abdo pressure
Overactive- associated with urgency due to detrusor overactivity
Others = voiding difficulties, fistula, neurological e.g. MS

Question 3

What is the most common type of incontinence

Answer 3

Stress

Question 4

What is uroflowmetry

Answer 4

Measures flow rates which enables you to measure peak and mean flow and voided volume.
Min 200ml required.

Question 5

What is cystometry

Answer 5

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

Question 6

What lifestyle changes are used to treat STRESS incontinence

Answer 6

Loose weight
Stop smoking - cough
Caffeine intake
Fluid intake

Question 7

What is an important part of the treatment of STRESS incontinence

Answer 7

pelvic floor training

Question 8

What drugs can be used to treat STRESS incontinence

Answer 8

Duloxetine - Noradrenaline and serotonin reuptake inhibitor- increases intra urethral closure pressure

Question 9

What surgical options are available for STRESS incontinence

Answer 9

Low tension vaginal tape
Intraurethral injection
Artificial sphincters
Colposuspension

Question 10

What physiotherapy is used for overactive bladder ie urge incontinence

Answer 10

Bladder training

Question 11

What drugs are used to treat overactive bladder

Answer 11

Oxybutynin - anti muscarinic
Decrease ability of detrusor muscle to contract by blocking muscarinic receptors

B3 receptor agonists - Amigendron

Question 12

What surgical options are there for overactive bladder

Answer 12

Botox injections
Sacral nerve modulation
Augmentation cystoplasty
Bladder overdistention

RARE

Question 13

What are the classifications or uterine descent

Answer 13

1st degree (in vagina),
2nd degree (at interiotus),
3rd degree (outside vagina) 
Procidentia (entirely outside vagina)

Question 14

Name the types of pelvic organ prolapse

Answer 14

urethrocele (urethra),
cytocele (bladder),
rectocele (rectum),
enterocele (pouch of Douglas containing small bowel)
vaginal vault
uterus and cervix

Question 15

When taking a prolapse organ history what are the groups of symptoms to consider

Answer 15

Urinary
Bowel
Sexual