Urology: incontinence

Question 1

What is stress incontinence?

Answer 1

Leaking of urine when intra-abdominal pressure is raised, putting pressure on bladder

Question 1

What are triggers of stress incontinence?

Answer 1

coughing, laughing, sneezing

Question 2

what are the RF for stress incontinence?

Answer 2

childbirth and hysterectomy, female, pregnant, chronic cough, smoker, weak pelvic floor

Question 3

Define urinary incontinence

Answer 3

Involuntary leakage of urine

Question 4

Name some general risk factors for urinary incontinence

Answer 4

Age, obesity, multiparty, vaginal birth, FHx, being female, PMH of stroke, DM, depression.

Question 5

What is the PERFECT mnemonic used for pelvic floor examination?

Answer 5

P= Power, E = Endurance, R = Repetition, Fast contraction, ECT = Every Contraction Timed

Question 6

How does stress incontinence present?

Answer 6

Urine leaks when increase intra abdo pressure e.g cough, sneeze, laugh, exercise, lift.
Woman. Older age. Smoker. Chronic cough may be present. Pregnant or childbirth. Pelvic or prostate surgery. Overweight/high BMI. Hysterectomy.

Question 7

Describe the pathophysiology of stress incontinence

Answer 7

Intra abdominal pressure exceeds the urethral pressure. Also have weak pelvic floor muscles

Question 8

What investigations may you do for suspected stress incontinence?

Answer 8

Ask pt to keep bladder diary.
Midstream urine dip.
Examine rectum (for prostate) and bladder.
Urodynamic assessment for detrusor muscle.
Outflow urodynamics. Cystoscopy.

Question 9

How is stress incontinence managed if pt has visible haematuria or non-visible haematuria?

Answer 9

Urgent 2ww.

Question 10

What lifestyle advice might you recommend to a pt with stress UI or urge UI?

Answer 10

Reduce caffeine intake, lose weight, advise on fluid intake, stop smoking.

Question 11

What surgical options are available for stress UI?

Answer 11

Colpususpension, sling surgery, vaginal mesh surgery, urethral bulking agents, artificial urinary sphincter.

Question 12

How does urge UI present?

Answer 12

High BMI pt, drinks caffeinated drinks. Has PMH of UTIs. Sudden intense urge to pee, followed by involuntary loss of wee. Nocturia. Pass urine during sex, when reaching orgasm.

Question 13

What is the pathophysiology of urge UI?

Answer 13

Overactive bladder leads to uninhibited bladder contractions. This increases intravesical pressure, causing urine to leak.

Question 14

How is urge UI managed (non-surgical)?

Answer 14

1)Need to exclude overflow UI. 2) Bladder training. 3) Prescribe antimuscarinic e.g. oxybutynin.

Question 15

How can urge UI be managed surgically?

Answer 15

Botox injections. Sacral nerve stimulation. Posterior tibial nerve stimulation. Augmentation cystoplasty. Urinary diversion.

Question 16

Define mixed UI

Answer 16

Stress and urge incontinence

Question 17

How does overflow incontinence present?

Answer 17

Small trickles of wee. Feel bladder is never empty. Can not empty when try to go. PMh of BPH.

Question 18

What is pathophysiology of overflow UI?

Answer 18

A complication of chronic urinary retention. Progressive stretching of bladder leads to damage of sacral reflex efferent fibres. Lose sensation of bladder. Bladder fills with urine and becomes distended. Intravesicular pressure builds, so get dribbling of urine out.

Question 19

What specific investigation may you want to do for suspected overflow UI?

Answer 19

Bladder scans pre and post voiding.

Question 20

What are surgical options for overflow UI?

Answer 20

Indwelling catheter, Clean intermittent catheter.

Question 21

How does continuous incontinence present?

Answer 21

Constant dribbling/leaking, needing to wear a pad. Affect daily life.

Question 22

Describe pathophysiology for continuous UI

Answer 22

Anatomical abnormality (e.g. ectopic ureter) or bladder fistula.

Question 23

What are complications of using botox to manage urge UI?

Answer 23

May need catheter to drain bladder

Question 24

Name a complication of a long term catheter?

Answer 24

UTIs!!!