Urogynae

Question 1

Overview of management options for SUI:

Answer 1

General measures

Conservative:

• Pelvic floor muscle training (1st line)
• Pessary with continence knob for exercise/activities

Medical:
- Duloxetine (3rd line)

Surgical:

• TVT (2nd line)
• Burch colposuspension (2nd line)
• Bulkamid
• Artificial urinary sphincters (3rd line)

Question 2

List general measures for all urinary incontinence:

Answer 2

• Fluid restriction 1-1.5L
• Avoid caffeine
• Smoking cessation
• Weight loss
• Review and adjust medications that affect bladder/urethral function
• Manage constipation

Question 3

Overview of management options for OAB:

Answer 3

General measures

Conservative:

• Weight loss
• Bladder drill retraining

Medical:

• Anticholinergic: oxybutynin 5 mg 2-3x daily, solifenacin 5 mg daily, desmopressin
• Topical HRT

Surgical:

• Botox type A bladder wall injection
• Percutaneous sacral nerve stimulation
• Augmentation cystoplasty
• Urinary diversion