7 - Female Urinary Incontinence

Question 1

which is the upper part of the urinary tract?

Answer 1

kidneys

ureters

Question 2

which is the lower part of the urinary tract?

Answer 2

bladder

urethra

Question 3

@ which rate does the bladder fill?

Answer 3

0.5-5 ml/ min

Question 4

describe the pressure of the lower urinary tract?

Answer 4

low-pressure storage of urine

Question 5

describe the transportation of urine via the upper urinary tract?

Answer 5

from nephrons via ureters to the bladder

Question 6

what does the vesico-ureteric mechanism do?

Answer 6

protects nephrons from damage 2y to retrograde transmission of back pressure/ infection from the bladder

Question 7

function of bladder filling?

Answer 7

accomodate increasing volume at constantly low pressure

Question 8

how does the bladder inhibit contractions?

Answer 8

gradual awareness of filling

Question 9

describe cortical activity?

Answer 9

Activates a reciprocal guarding reflex by Rhabdosphincter contraction; increase sphincter contraction & resistance

Question 10

describe the 4 actions which contribute to bladder emptying?

Answer 10

Detrusor contraction

Urethral Relaxation

Sphincter co-ordination

Absence of Obstruction

Question 11

define urinary incontinence?

Answer 11

any involuntary leakage of urine

Question 12

define stress urinary incontinence?

Answer 12

involuntary leakage on effort/ exertion, on sneezing/ coughing

Question 13

define urge urinary incontinence?

Answer 13

involuntary leakage accompanied by/ immediately preceded by urgency

Question 14

define mixed urinary incontinence?

Answer 14

involuntary leakage accompanied by/ immediately preceded by urgency and on effort/exertion, or by sneezing/coughing

Question 15

relationship of age and UI?

Answer 15

risk increases with age

Question 16

name 4 impacts of UI?

Answer 16

Reduce social relationships and activities

Impair emotional and psychological well- being

Impair sexual relationships

Embarrassment and reduced self- esteem

Question 17

what is the greatest risk factor for UI?

Answer 17

pregnancy/ childbirth

Question 18

name 5 other risk factors for UI?

Answer 18

age

menopause

smoking

connective tissue disease

pelvic floor trauma

Question 19

4 factors of patient assessment?

Answer 19

History
Examination
Investigations
Management

Question 20

3 important questions during history?

Answer 20

mode of past deliveries

weight of heaviest baby

HRT

Question 21

4 important questions during history - PMH, D+A?

Answer 21

glaucoma

anti-HTN meds

cognitive problems

previous surgeries for SUI/POP

Question 22

5 irritation symptoms from patient’s complaint?

Answer 22

Urgency

Increased daytime frequency (>7)

Nocturia (>1)

Dysuria

Haematuria

Question 23

name 3 incontinence symptoms?

Answer 23

Stress UI

Urgency UI

Coital Incontinence

Question 24

3 voiding symptoms?

Answer 24

Straining to void

Interrupted flow

Recurrent UTI

Question 25

2 prolapse symptoms?

Answer 25

Vaginal Lump Dragging sensation in vagina

Question 26

4 bowel symptoms?

Answer 26

Anal Incontinence Constipation faecal evacuation dysfunction IBS

Question 27

2 methods of measuring UI?

Answer 27

3 days urinary diary urine dipstick

Question 28

5 examinations to be carried out for women with bladder issues?

Answer 28

``` General Abdominal Neurological Gynaecological Pelvic floor assessment ```

Question 29

How is pelvic floor assessed?

Answer 29

Oxford Scale

Question 30

3 investigations of UI?

Answer 30

urinalysis post voiding residual volume assessment urodynamics

Question 31

4 methods of management for UI?

Answer 31

lifestyle changes medical treatments physiotherapy surgery

Question 32

describe 4 lifestyle changes to help UI?

Answer 32

smoking cessation Lose weight Eat more healthily to avoid constipation Stop drinking alcohol and caffeine

Question 33

describe 3 benefits of PFMT - pelvic floor muscle training?

Answer 33

reinforcement of cortical awareness hypertrophy of existing muscle fibres general increase in muscle tone and strength

Question 34

which drug is used for moderate to severe stress incontinence?

Answer 34

Duloxetine

Question 35

who should recieve duloxetine in 1y care?

Answer 35

if PFMT needs improving or has not worked at all

Question 36

who should recieve duloxetine in 2y care?

Answer 36

those who - - do not wish surgery - are not fit for surgery - have had failed surgery

Question 37

TVT - what is this used for?

Answer 37

Tension-free Vaginal Tape - used as a minimally invasive procedure

Question 38

what does TVT depend on?

Answer 38

the hammock theory for continence

Question 39

which is 1st line surgical treatment for SUI - TVT or colposuspension?

Answer 39

TVT

Question 40

3 complications of TVT?

Answer 40

bladder perforation vaginal and urethral erosions vascular injuries

Question 41

define Overactive Bladder Syndrome (OBS)?

Answer 41

A symptom complex usually, but not always, related to urodynamically demonstrable detrusor overactivity (DO)

Question 42

defining symptoms for OBS?

Answer 42

urgency frequency nocturia

Question 43

define urgency?

Answer 43

The complaint of a sudden, compelling desire to pass urine that is difficult to defer

Question 44

define urge incontinence?

Answer 44

The complaint of involuntary leakage of urine accompanied or immediately preceded by urgency

Question 45

define frequency?

Answer 45

Usually accompanies urgency with or without urge incontinence and is the complaint by the patient who considers that he/she voids too often by day

Question 46

define nocturia?

Answer 46

Usually accompanies urgency with or without urge incontinence and is the complaint that the individual has to wake at night one or more times to void

Question 47

name 3 antimuscarinic oral drugs to treat OBS?

Answer 47

Solifenacin Fesoteridine Trospium Chloride

Question 48

name a antimuscarinic transdermal drug to treat OBS?

Answer 48

kentera patches

Question 49

name a tri-cyclic antidepressant to treat OBS?

Answer 49

imipramine