urinary incontinence

Question 1

what is stress urinary incontinence?

Answer 1

leakage on effort, exertion, sneezing or coughing

Question 2

what causes stress urinary incontinence?

Answer 2

occurs as a result of bladder neck/urethral hypermobility and/or neuromuscular defects causing intrinsic sphincter deficiency
urine leaks when urethral resistance is exceeded by increased abdo pressure

Question 3

what is urge urinary incontinence?

Answer 3

leakage accompanied by or immediately preceded by urgency.
may be due to bladder overactivity or less commonly due to pathology that irritates the bladder (infection, tumour, stone)

Question 4

what warrants an urgent urology referral?

Answer 4

nocturnal enuresis in elderly men that wasn’t happening before

Question 5

what does a constant leakage of urine suggest?

Answer 5

a fistulous communication between the bladder and vagina, or the presence of an ectopic ureter draining into the vagina

Question 6

what controls the urge to pee?

Answer 6

the pontine micturition centre

Question 7

what are some risk factors for incontience?

Answer 7

female
Caucasian
neurological disorders
anatomical disorders
child birth
pelvic, perineal and prostate surgery
radical pelvic radiotherapy
diabetes

Question 8

what are some promoting factors for incontinence?

Answer 8

smoking (causes cough)
obesity
UTI
increased fluid intake
poor nutrition
age
cognitive deficit
poor mobility
oestrogen deficiency

Question 9

what are some red flag symptoms in incontinence?

Answer 9

pain
haematuria
recurrent UTI
significant voiding/obstructive symptoms
history of pelvic surgery/radiotherapy

Question 10

what are some investigations for incontinence?

Answer 10

bladder diary (frequency and volume)
urinalysis +/- culture
flow rate
pad testing
bloods
imaging
cystoscopy (complex cases)

Question 11

what is cystometry?

Answer 11

measures the pressure in the bladder
tries to establish if the bladder is where the issues are

Question 12

what are some conservative treatments of incontinence?

Answer 12

pelvic floor exercises
lifestyle modifications- WL, smoking cessation, avoid constipation, limit caffeine

Question 13

what are some pharmacological treatments of incontinence?

Answer 13

duloxetine (increases sphincter muscle activity during bladder filling)

Question 14

what are the surgical treatments of incontinence?

Answer 14

injection therapy- injection of bulking materials into the bladder neck to increase outlet resistance
main indication is for female stress incontinence secondary to intrinsic sphincter deficiency

Question 15

what treatment is used to treat female stress incontinence caused by urethral hypermobility?

Answer 15

retropubic suspension
requires good vaginal mobility
success rate of 70% after 5 years

Question 16

what is used to prevent urethral movement

Answer 16

pubovaginal slings

Question 17

what are the features of an artificial urinary sphincter?

Answer 17

1. an inflatable cuff placed around the bulbar urethra or bladder neck
2. a pressure regulating baloon placed extraperitoneally in the abdomen
3. an activating pump in the scrotum or labia majora

Question 18

what is an overactive bladder?

Answer 18

a symptom syndrome that includes urgency with or without incontinence, usually with frequency and nocturia
usually caused by bladder (detruser) overactivity

Question 19

what is the conservative treatment of an OAB?

Answer 19

pelvic floor exercises
behavioural modifications

Question 20

what can be used for bladder overactivity?

Answer 20

anticholingeric (antimuscarinic) drugs
eg fesoterodine

Question 21

what is the last line option of an OAB?

Answer 21

botox- injected at multiple (20) sites under the bladder mucosa or into detrusor, sparing the trigone