Urinary Problems

Question 1

Urinary symptoms

Answer 1

Rarely solely stress or urge incontinence, most people will also have some frequency or urgency or nocturia (mix of wet and dry symptoms) Hard to predict detrusor instability based on symptoms alone

Question 2

Urinary diary

Answer 2

Intended to measure intake and output of fluid to estimate functional capacity, frequency of voiding and frequency of incontience

Question 3

Investigations of urinary symptoms

Answer 3

Urodynamics - flow rate (~15mls/s), urinary residual, bladder capacity and detrusor function
Exclude UTI

Question 4

Treatment of incontinence

Answer 4

Conservative - pregnancy, unfit for surgery or only mild problems
lifestyle changes - reduce fluid intake, exclude UTI, improve mobility and sleep

Question 5

Treatments of Overactive bladder (OAB) or Detrusor instability (DI)

Answer 5

Pathology not understood but symptomatic treatment possible

Variety of treatments including drugs, bladder training, psychotherapy, acupuncture, hypnotherapy or surgery

Question 6

Overactive bladder (OAB) or Detrusor instability (DI)

Answer 6

Starts with incontience and moves to frequency
Nocturia is common in older women anyway
sexual dysfunction affects 1/3 of women with DI

Question 7

Drug treatments for Overactive bladder (OAB) or Detrusor instability (DI)

Answer 7

Anticholinergics (Propiverine)
Musculotropic relaxants (oxybutynin)
Antimuscarinics (Toterodine/detrusitol)

Question 8

Imipramine

Answer 8

Useful for nocturia and works synergistically with other drugs
Also useful for intercourse incontinence

Question 9

Estrogen replacement

Answer 9

No evidence it cures DI
but is good for atrophic vaginitis or urethritis
Reduces the frequency of UTIs
can improve sensory urgency

Question 10

DDAVP

Answer 10

Demopressin - used to treat nocturia but care should be taken if the patient has heart failure

Question 11

Stress incontience

Answer 11

If mild treat with pelvic floor training or vaginal devices, if more severe use fluid restriction or void before stress events

Question 12

Vaginal delivery and the pelvic floor

Answer 12

14% will have long standing dyspareunia after SVD

35% have sonographic evidence of anal sphincter damage

Question 13

Prevalence of urinary problems

Answer 13

14-20% of women effected - under recognised and under treated
Mainly OAB and stress incontinence
Majority treated conservatively

Question 14

Treatment of Isolated idiopathic urinary frequency

Answer 14

Fluid restriction is often effective on its own.