Urinary Incontinence and Prolapse

Question 1

Leakage of urine during raised intra-abdominal pressure

Answer 1

Stress urinary incontinence

Question 2

Leakage associated with urgency, usually with detrusor activity

Answer 2

Overactive bladder

Question 3

What could cause voiding difficulties?

Answer 3

Detrusor hypotonia

Overflow

Question 4

Neurological conditions that could cause urinary incontinence?

Answer 4

Multiple sclerosis

Diabetes

Question 5

Most common type of urinary incontinence?

Answer 5

Stress urine incontinence (48%)

Question 6

This records voided volumes, frequencies and UI episodes

Answer 6

Bladder chart

Question 7

This quantifies urine leakage over specified time

Answer 7

Pad test

Question 8

Why would you study urodynamics?

Answer 8

Can differentiate between stress incontinence and overactive bladder (urge incontinence) in patients in whom surgey is considered

• includes uroflowmetry
• cystometry

Question 9

Lifestyle measures to treat stress urinary incontinence

Answer 9

Lose weight
Stop smoking
Avoid caffeinated drinks
Avoid excessive fluid intake

Physiotherapy - pelvic floor muscles etc

Question 10

Drugs for stress urinary incontinence

Answer 10

Duloxetine

SNRI

Question 11

Drugs for OAB

Answer 11

Oxybutynin

B3 antagonists

Question 12

How does duloxetine work?

Answer 12

SNRI (stops NA and 5HT uptake)

-increases intraurethral closure pressure

Question 13

How does oxybutynin work?

Answer 13

Blocks detrusor muscarinic receptor

= decreases detrusor contractibility

Question 14

1st degree prolapse

Answer 14

In vagina

Question 15

2nd degree prolapse

Answer 15

At introitus

Question 16

3rd degree prolapse

Answer 16

Outside vagina

Question 17

Procidentia

Answer 17

Entirely outside vagina

Question 18

What is an enterocele?

Answer 18

Type of prolapse involving pouch of douglas containing small bowel

Question 19

Symptoms of rectocele?

Answer 19

constipation

dyschezia

Question 20

Symptoms of cystourethrocele?

Answer 20

• stress urinary incontinence
• urinary retention,
• recurrent UTI

Question 21

What investigations should you do if someone with prolapse has significant urinary symptoms?

Answer 21

MSSU
Bladder chart
Consider drug treatment/referral urodynamics

Question 22

Conservative management for uterovaginal prolapse

Answer 22

VAGINAL OESTROGENS - only if symptomatic atrophic vaginitis

• avoid lifting heavy weights
• stop smoking
• lose weight
• reduce constipation

Question 23

When can you give vaginal oestrogens for prolapse?

Answer 23

Only if atrophic vaginitis

Question 24

When can you consider surgical management for prolapse?

Answer 24

ONLY after failed conservative management and if major impact on quality of life

Question 25

Which ligament could you attach the vaginal vault to?

Answer 25

Sacrospinous ligament | sacrospinous ligament fixatiton

Question 26

M1

Answer 26

Brain (cortex and hippocampus) Salivary glands Cognitive functioning and memory Saliva secretion

Question 27

M2

Answer 27

Heart, brain, smooth muscle

Question 28

M3

Answer 28

Smooth muscles, glands, eye (control iris contraction)

Question 29

M4

Answer 29

Brain | -modulation of several important dopamine-dependent behaviours

Question 30

M5

Answer 30

Brain (substantia nigra) | -regulation of striatal dopamine release

Question 31

What could lead to a woman developing a fistula

Answer 31

Cervical cancer | Obstructive labour

Question 32

Why might you check bloods in someone with urinary incontinence?

Answer 32

Want to check renal function if you suspect renal impairment

Question 33

This investigation allows you to measure peak flow, mean flow and voided volume

Answer 33

Uroflowmetry

Question 34

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

Answer 34

Cystometry