Week 8 - Urinary Incontinence

Question 1

State the innervation of the external urethral sphincter

Answer 1

-Somatic innervation S2-S4 (pudendal nerve)

Question 2

What type of incontincence is caused by a lower motor lesion of S2-S4? What are the associated symptoms?

Answer 2

• Chronic urinary retention leading to overflow incontinence

- Reduced perianal sensation and lax anal tone

Question 3

What type of incontinence is caused by upper motor neurone lesion of S2-S4?

Answer 3

-Detrusor Sphincter dyssynergia as there are frequent high pressure detrusor contractions which are poorly coordinated with sphincters

Question 4

Why do you get hydroureter in detrusor sphincter dyssynergia? What can this lead to?

Answer 4

-Backflow of pressure created by contractions of detrusor causes dilation of ureter and can lead to AKI

Question 5

What is urinary incontinence? Name the types

Answer 5

• The complaint of any involuntary leakage of urine
• Stress incontinence
• Urge incontinence
• Mixed incontinence
• Overflow incontinence

Question 6

What is stress incontinence?

Answer 6

• Problems with the external urethral sphincter exacerbated on exertion eg coughing or sneezing
• Common after childbirth

Question 7

What is urge urinary incontinence?

Answer 7

-Involuntary leakage proceeded by urgency

Question 8

What is overactive bladder syndrome?

Answer 8

-Urgency, frequency and nocturia

Question 9

Which is the most common urinary incontinence?

Answer 9

-Stress incontinence

Question 10

Name some obs and gyne risk factors for incontinence?

Answer 10

• Pregnancy and childbirth

- Pelvic prolapse

Question 11

Name some promoting factors of urinary incontinence

Answer 11

• Obesity
• Age
• Menopause
• Cognitive impairment

Question 12

What investigations must be done if urinary incontinence is suspected?

Answer 12

• History to classify type of incontinence
• Abdo examination to exclude palpable bladder
• DRE in males/Stress test/vaginal exam in women
• Urine dipstick is mandatory
• Non-invasive urodynamics eg frequency-volume chart
• Invasive urodynamics eg pressure-flow study

Question 13

What general lifestyle interventions can be done to manage urinary incontinece?

Answer 13

• Modify fluid intake
• Weight loss
• Smoking and caffeine
• Timed voiding
• Incontinence pads

Question 14

What types of catheter can be intoduced to manage UI?

Answer 14

• Indwelling catheter

- Sheath catheter

Question 15

What is highly recommended in women to prevent urinary incontinence?

Answer 15

• Pelvic floor exercises

- 8 contractions 3x day for at least 3 months

Question 16

Discuss the pharmacological management of stress urinary incontinence

Answer 16

-NA and serotonin uptake inhibitor to increase activity of EUS

Question 17

Discuss the pharmacological management of urge urinary incontinence

Answer 17

• Anticholinergics to block parasympathetic contraction(oxybutynin)
• Boltulinin toxin inhibits Ach release

Question 18

Discuss the pharmacological management of overactive urinary incontinence

Answer 18

-B3-adrenoreceptor agonist to increase bladder capacity to store urine by relaxing detrusor

Question 19

Describe surgical management of stress incontinence for males and females

Answer 19

• Females-> Low-tension vaginal tapes to support urethra, retropubbic suspension
• Males -> artificial urinary sphincter

Question 20

Describe surgical management of urge incontinence

Answer 20

• Sacral nerve neuromodulation

- Urostomy

Question 21

Describe the incidence and prevalence of urinary incontinence

Answer 21

• SUI accounts for approximately 50% of incidence followed by mixed then urge the other
• Prevalence increases with age with over 35% having ui over 75

Question 22

What is the detrusor? State its innervation

Answer 22

• Muscular component of the bladder

- Parasympathetic innervation S2-S4