Urinary Incontinence - Urge

Question 1

ESSENCE

Answer 1

Caused by overactivity of detrusor muscle of bladder

Sudden urge to urinate, needing to rush to bathroom, becomes always worried about sudden access to toilet

Question 2

CLINICAL FEATURES

Presentation

Answer 2

• Involuntary urine leakage accompanied by or immediately preceeded by urgency
• Frequency of urination

Question 3

INVESTIGATIONS

First choice

Answer 3

• Same as urge incontinence
  
  • Bladder diary
  • Dipstick
  • Post-void residual bladder volume
• Plus urodynamic testing

Question 4

How are urodynamic tests performed

Answer 4

Thin catheter inserted into bladder and another into rectum, these measure pressures in both for comparison

Bladder is filled with liquid and various outcome measures and taken

Question 5

What are different outcome measures urodynamic tests can measure

Answer 5

• Cystometry (detrusor muscle contraction and pressure)
• Uroflowmetry (flow rate)
• Leak point pressure (point at which bladder pressure causes leakage of urine)
• Post-void residual bladder volume (incomplete emptying)
• Video urodynamic testing (use contrast and x-ray as bladder empties)
  
  • Only performed when necessary, not routine

Question 6

MANAGEMENT

General principles

Answer 6

• Bladder retraining
• Anticholinergic medication
• Mirabegron (alternative to anticholinergic medication)
• Invasive procedures (where medical treatment has failed)

Question 7

What needs done before urodynamic tests

Answer 7

Anticholinergic medication needs stopped at least 5 days before

Question 8

MANAGEMENT

Anticholinergic medication choices

Answer 8

• Oxybutynin
• Tolterodine
• Solifenacin

Question 9

When is micrabegron contraindicated

Answer 9

Uncontrolled hypertension, could cause hypertensive crises leading to TIA and stroke

Question 10

What are anticholinergic side effects

Answer 10

• Dry mouth
• Dry eyes
• Urinary retention
• Constipation
• Postural hypotension
• Can lead to cognitive decline, memory problems and worsening of dementia

Question 11

MANAGEMENT

Invasive options

Answer 11

• Botulinum toxin type A
• Percutaneous sacral nerve stimulation
• Augmentation cystoplasty
• Urinary diversion

Question 12

What is percutaneous sacral nerve stimulation

Answer 12

Implanting device into back that stimulates sacral nerves

Question 13

What is augmentation cystoplasty

Answer 13

Using bowel tissue to enlarge bladder

Question 14

What is urinary diversion

Answer 14

Redirecting urinary flow to a urostomy on abdomen