Urinary Incontinence

Question 1

Outline the possible storage symptoms of urinary incontinence

Answer 1

Frequency

Urgency

Nocturia

Incontinence

Question 2

Outline the possible voiding symptoms of urinary incontinence

Answer 2

Slow stream

Spitting/spraying

Intermittency

Hesitancy

Straining

Terminal dribble

Question 3

Outline the possible post-micturition symptoms of urinary incontinence

Answer 3

Post-micturition dribble

Feeling of incomplete emptying

Question 4

What is urinary incontinence?

Answer 4

The complaint of any involuntary leakage of urine

Question 5

What is stress urinary incontinence?

Answer 5

Involuntary leakage on effort or exertion, or on sneezing or coughing

Question 6

What is urge urinary incontinence?

Answer 6

Involuntary leakage of urine accompanied by or immediately proceeded by urgency

Question 7

What is mixed urinary incontinence?

Answer 7

Involuntary leakage or urine associated with urgency and also with exertion, effort, sneezing or coughing

Question 8

Outline overflow incontinence

Answer 8

Involuntary release of urine from an overfull urinary bladder, often in the absence of any urge to urinate

Neural lesion = between S2-S4

Question 9

Outline risk factors for urinary incontinence relating to obstetrics and gynaecology

Answer 9

Preg

Childbirth

Pelvic surgery

Pelvic prolapse

Question 10

What are the promoting risk factors for urinary incontinence

Answer 10

Race

Family predisposition

Anatomical abnormalities

Neurological abnormalities

Question 11

Outline the predisposing risk factors relating to urinary incontinence

Answer 11

Co-morbidities

Obesity

Age

Increased intra-abdo pressure

UTI

Drugs

Menopause

Question 12

Briefly outline the investigations used to aid diagnosis of urinary incontinence

Answer 12

Urine dipstick = UTI, haematuria, proteinuria, glucosuria

Frequency-volume chart

Bladder diary

Post-Micturition residual volume – in pts with voiding dysfunction

Pressure-flow studies +/- video

Pad tests

Cystoscopy

Question 13

What lifestyle modifications can take take to help address urinary incontinence?

Answer 13

Modify fluid intake

Weight loss

Stop smoking

Decrease caffeine intake

Avoid constipation

Timed voiding

Question 14

Outline treatment options for pts unsuitable for surgery and who have failed conservative management

Answer 14

Indwelling catheter = indwelling, suprapubic

Sheath device = adhesive condom attached to catheter tubing and bag

Incontinence pads

Question 15

What is the initial management for stress urinary incontinence?

Answer 15

Pelvic floor muscle training

Question 16

What are the male and female surgery options for stress urinary incontinence?

Answer 16

Females = low tension vaginal tapes, intramural bulking agents

Males = artificial urinary sphincter, male sling procedure

Question 17

How is urge urinary incontinence initially managed?

Answer 17

Bladder training = schedule of voiding

Question 18

What is the pharmacological management for urge urinary incontinence?

Answer 18

Anticholinergics = act on muscarinic receptors M2 and M3

Beta-3 adrenoceptor agonist = increases bladders capacity to store urine

Question 19

What are the surgical options when treating urge urinary incontinence?

Answer 19

Sacral N neuromodulation

Autoaugmentation

Urinary diversion