UROLOGY - INCONTINENCE

Question 1

What is stress urinary incontinence?

Answer 1

involuntary urine leakage on effort, exertion, sneezing or coughing

Question 2

What is urge urinary incontinence?

Answer 2

involuntary urine leakage accompanied or immediately preceded by urgency

Question 3

What is mixed urinary incontinence?

Answer 3

involuntary urine leakage associated with both urgency and exertion, effort, sneezing or coughing

Question 4

What is overactive bladder?

Answer 4

urgency that occurs with or without urgency urinary incontinence and usually with frequency and nocturia.

Question 5

How do you assess urinary incontinence?

Answer 5

Categorise as stress, urge or mixed
Assess pelvic floor muscles
Urine dipstick
Measure post-void residual volume
Use bladder diaries

Question 6

What are some non-surgical interventions that could improve urinary incontinence?

Answer 6

Caffeine reduction
Modify fluid intake
Lose weight if BMI >30
Pelvic floor muscle training
Bladder training
Catheters

Question 7

What medicines are used for overactive bladder?

Answer 7

Anticholinergic meds

Question 8

How can detrusor overactivity be treated if not responsive to meds?

Answer 8

Bladder wall injection with botulinum toxin type A
If this doesnt work either then offer percutaneous sacral nerve stimulation
If not then offer augmentation cystoplaty
If not then offer urinary diversion

Question 9

How is stress urinary incontinence managed surgically?

Answer 9

Mesh
Colposuspension
Autologous recuts fascial sling
Retro pubic mid-urethral mesh sling
Intramural bulking agents

If all else fails then offer an artificial urinary sphincter

Question 10

What is functional incontinence?

Answer 10

Due to physical or cognitive impairment e.g. dementia or inaccessible toilet facilities

Question 11

What is overflow incontinence?

Answer 11

when you’re unable to fully empty your bladder, which causes frequent leaking

Question 12

What anticholinergic are used first line for urinary incontinence?

Answer 12

Oxybutinin hydrochloride

Question 13

What can be used for urinary incontinence if anticholinergic are contraindicated?

Answer 13

Mirabegron - beta 3 adrenergic receptor agonist (relaxes detrusor smooth muscle)

Question 14

What is urinary retention?

Answer 14

the inability to voluntarily urinate

Question 15

Whats the difference between acute and chronic urine retention?

Answer 15

Acute is sudden inability to urinate in the presence of a painful bladder
Chronic is the presence of a large, painless bladder with or without difficulty in micturation

Question 16

What are the 3 most common causes of retention in men?

Answer 16

BPH
Prostatic maliganncy
Urethral strictures

(Other causes include constipation, stones, clot retention, post-operative, drugs, neurological disease)

Question 17

Which drugs can cause retention?

Answer 17

Anticholinergic
Antihistamines
Some antipsychotics
Sympathomimetic drugs - increase alpha adrenergic tone in prostate and bladder neck

Question 18

How do you manage acute retention?

Answer 18

Urgent catheterisation
Alpha blocker at least 24 hours before removing catheter

Question 19

What is a vesicovaginal fistula and when should you suspect it?

Answer 19

Abnormal opening that forms between the bladder and wall of vagina
Continuous urine leakage through the vagina after obstetric or gynaecological injury e.g. surgery

Question 20

How should you investigate suspected vesicovaginal fistula?

Answer 20

Urine dye studies - dye stains urine and hence identifies the presence of a fistula on imaging

Question 21

What is a high voiding detrusor pressure with a low peak flow rate is indicative of?

Answer 21

Bladder outlet obstruction