Urinary Incontinence and Prolapse

Question 1

At what point does the bladder signal for voiding?

Answer 1

400ml full

Question 2

What is the micturition reflex?

Answer 2

This is parasympathetics that supply the bladder sending signals to the spinal bladder center (S2,3). There are descending controls from the brain to prevent overactive detrusor muscle. When bladder reaches the right volume and distension then there is signal to void

Question 3

What is meant by overflow incontinence?

Answer 3

This is incontinence due to obstruction of the bladder inhibiting micturition. There will be a large and palpable bladder with discomfort. Patients may also present with being wet at night

Question 4

How is overflow incontinence treated?

Answer 4

Need to confirm by examination (will be uncomfortable, can’t get below it, dull percussion) then locate the obstruction. Catheterise to relieve the pressure and fix the obstruction

Question 5

What is urge incontinence?

Answer 5

This is an increase in frequency but a decrease if urinary voiding volume due to an overactive detrusor muscle.

Question 6

What can cause an overactive detrusor?

Answer 6

irritation within the bladder

lack of descending controls from the brain

Question 7

What is used to diagnose urge incontinece?

Answer 7

Urodynamics - will have multiple spikes

Question 8

What is used to treat urge incontinence?

Answer 8

Dietary adjustment, bladder retraining, antimuscurinics (oxybutynin) or beta-3-adrenergics, can use botox injections or surgery

Question 9

What is stress incontinence?

Answer 9

This is incontinence due to increased abdominal pressure without the presence of detrusor contraction. It is mainly caused by childbirth causing damage to the perineum and urethra
usually brought on by coughing/laughing

Question 10

How is stress incontinence diagnosed?

Answer 10

Urodynamics (to exclude urge)

Question 11

How is stress incontinence treated?

Answer 11

diet, pelvic floor exercised, (duloxetine) and surgery (can do minimally invasive taping procedure)

Question 12

What are some UI symptoms?

Answer 12

frequency, urge, nocturia, stress, OAB

voiding: hestitancy, incomplete, difficulty, spraying

Question 13

What examinations should be done for UI?

Answer 13

BMI, abdo (masses, bladder), vaginal (prolapse), PR (masses), cognitive impairment assessment

Question 14

What investigations should be carried out for UI?

Answer 14

urinalysis, post void residual, urodynamics, cystoscopy, imaging

Question 15

Oxybutynin and tolteride are examples of…

Answer 15

anti-muscurinics

Question 16

Explain anti-muscurinic action in UI

Answer 16

will block the cholinergic action of the parasympathetics to reduce the tone and voiding frequency
examples include oxybutynin and tolteride

Question 17

Mirabegron is an example of…

Answer 17

beta-3-agonist

Question 18

beta-3-agonists are…

Answer 18

potentiators of sympathetic supply to the detrusor - causes relaxation

Question 19

What can be used in the treatment of OAB (pharma)

Answer 19

oxybutynin, tolteride or mirabegron

Question 20

What is significant about the use of antimuscurinics?

Answer 20

50% of patients will stop within 3 months due to side effects and lack of effect

Question 21

What are some side effects of AMs?

Answer 21

dry mouth, constipation, visual blurring and solomnence

Question 22

What is a cystocele?

Answer 22

This is involving the ANTERIOR compartment. it is the prolapse of the bladder into the vagina

Question 23

What is a vaginal vault prolapse?

Answer 23

AKA an enterocele. This involves the Middle/APICAL compartments and is the prolapse of the vagina due to compression from the bowel.

Question 24

What is a retrocele?

Answer 24

This involves the POSTERIOR compartment. It is the prolapse of the rectum into the vagina

Question 25

How is POP diagnosed?

Answer 25

It is mainly a clinical diagnosis based off symptoms and examination but there can be difficulty in the determining the origin. Can use USS and MRI to differentiate

Question 26

How are POP recorded?

Answer 26

POP-quantification score (positive numbers if below the hymen)

Question 27

How are POPs staged?

Answer 27

1 = >1cm above hymen
2 = -1-1 cm in relation to hymen
3 = >1cm beyond hyem
4 = full vaginal emersion

Question 28

What is the management of posterior and anterior prolapse?

Answer 28

Vaginal repair

Question 29

What is the management of an apical prolapse?

Answer 29

Pessaries or surgery

Question 30

Give some symptoms of prolapse?

Answer 30

bulging, pressure, pain on intercourse, difficulty inserting tampon

Question 31

If posterior prolapse what symptoms would occur?

Answer 31

difficulty with defecation and incomplete

Question 32

If anterior prolapse then what symptoms would occur?

Answer 32

difficulty voiding and incomplete