urinary incontinence and prolapse

Question 1

define stress incontinence

Answer 1

leakage on exertion

Question 2

define urge incontinence

Answer 2

leakage accompanied or immediately preceded by urgency

Question 3

define mixed incontinence

Answer 3

leakage associated with both urgency and stress

Question 4

aetiology of incontinence

Answer 4

age 
parity
obesity
pregnancy
obstetric history 
menopause 
UTI
smoking 
FHx

Question 5

examples of storage symptoms

Answer 5

frequency
nocturia
urgency
UUI
SUI
constant leak

Question 6

examples of voiding symptoms

Answer 6

hesitancy
straining to void
poor flow

Question 7

what physical examinations might be helpful in the investigation of urinary incontinence

Answer 7

BMI
abdo exam (masses)
vaginal exam (atrophy, prolapse, SUI, fistula)
PR (masses, tone)
cognitive impairment

Question 8

which investigations might be required to diagnose urinary incontinence

Answer 8

urinalysis 
post ovoidal residual 
urodynamics 
cystoscopy 
imaging

Question 9

conservative management of incontinence

Answer 9

reduce caffeine intake 
fluid intake 1.5-2.5 L
weight loss
PFE - 3 months 
bladder retraining - 6 weeks

Question 10

examples of antimuscarinics used to treat incontinence

Answer 10

oxybutynin
tolterodine
darifenicin

Question 11

how do antimuscarinics help incontinence

Answer 11

reduce intra-vesicle pressure
increase compliance
raise volume threshold for micturition
reduce uninhibited contractions

Question 12

side effects of antimuscarinics

Answer 12

dry mouth
constipation 
blurred vision
somnolence 
link to dementia

Question 13

example of B3 agonist

Answer 13

mirabegron

Question 14

action of mirabegron

Answer 14

relaxes bladder smooth muscle through activation of the B3 adrenoreceptor
increase voiding interval and inhibit spontaneous bladder contraction during filling

Question 15

overactive bladder management

Answer 15

desmopressin (if nocturia)
topical oestrogen 
botox
precutaneous sacral nerve stimulator 
augmentation cystoplasty

Question 16

surgical management of stress incontinence

Answer 16

tension free tape
colposuspension
intramural bulking agents
artificial sphincters

Question 17

what are the three compartments of prolapse

Answer 17

anterior (bladder)
middle or apical (uterus)
posterior (rectum)

Question 18

why is the incidence of female pelvic organ prolapse increasing

Answer 18

women’s life expectancy is increasing

increased expectations for quality of life

Question 19

what is a cystocele

Answer 19

bladder prolapsing into vagina

Question 20

symptoms of a cystocele

Answer 20

bulging 
pressure 
'mass'
difficulty voiding 
incomplete emptying 
splinting vaginal wall
difficulty inserting tampon
pain with intercourse

Question 21

what is an enterocoele

Answer 21

vaginal vault prolapse

Question 22

symptoms of enterocoele

Answer 22

bulging
pressure
'mass'
difficulty voiding
incomplete emptying 
splinting vaginal wall
difficulty inserting tampon
pain with intercourse

Question 23

what is a rectocele

Answer 23

rectum prolapsing into vagina

Question 24

symptoms of rectocele

Answer 24

bulging 
pressure
'mass'
difficulty defecating 
splinting vaginal wall or perineum
difficulty inserting tampon

Question 25

aetiology of prolapse

Answer 25

age
parity and vaginal delivery
postmenopausal oestrogen deficiency
obesity
neurological condition eg spina bifida and muscular dystrophy
genetic connective tissue disorder (marfans, EDS)

Question 26

investigation of prolapse

Answer 26

clinical diagnosis 
USS
MRI
anorectal manometry 
endoanal USS