Urogynae - Urge incontinence, Stress incontinence, Prolapse

Question 1

Urinary incontinence
-risk factors
-classification
-initial investigations

Answer 1

Age
Pregnancy, vaginal delivery
High BMI
Hysterectomy
FHx

Urge - detrusor overactivity
Stress - leaks when coughing, laughting
Mixed - both urge and stress
Overflow - bladder outlet obstruction

Bladder diary - 3days minimum
Vaginal examination
-assess for prolapse and ability to contract pelvic floor
Urine dip and culture
-rule out UTI related incontinence
Urodynamic studies

Question 2

Urge incontinence
-management

Answer 2

Bladder retraining - min 6wks
-gradually increase interval between voiding

Medications
-oxybutynin IR - avoid in frail older women
-tolterodine IR
-darifenacin, solifenacin
-mirabegron

Question 3

Stress incontinence
-management

Answer 3

Pelvic floor training
-8 contractions TDS for a minimum of 3 months

Surgical
-retropubic mid-urethral tape

Medications
-duloxetine => increased stimulation of sphincter muscles

Question 4

Urogenital prolapse
-what is it
-types
-risk factors
-presentation
-management

Answer 4

Descent of pelvic organs resulting in protrusion on vaginal walls

Cystocele
Cystourethrocele
Rectocele
Uterine prolapse
Enterocele

Age
Multiparity, vaginal deliveries
Obesity
Spina bifida

Pressure, heaviness
Urinary symptoms - incontinence, frequency, urgency

Asymptomatic or mild => no treatment
Conservative - weight loss, pelvic floor muscle exercise
Ring pessary
Surgery
-colposuspension, hysterectomy, sacrohysteropexy,