Clinical Evaluation of Urinary Incontinence

Question 1

DIAPPPERS

Answer 1

 Delirium
 Urinary infection / urethritis
 Atrophic vaginitis / urethritis
 Drug side effects
 Psychologic
 Pregnancy
 Excess urine production
 Metabolic (hyperglycemia, hypercalcemia)
 Excess fluid intake
 Volume overload
 Restricted mobility
 Fecal impaction

Question 2

Cough Stress Test

Answer 2

300 cc in the bladder

Question 3

Indications for cysto with urinary incontinence

Answer 3

Hematuria
 Recurrent UTIs
 Suspicion for foreign body or fistula
 If refractory or acute-onset urgency incontinence

Question 4

Stress Urinary Incontinence treatment

Answer 4

Kegel exercises
Pelvic floor PT
Medical therapy
Mechanical devices

Question 5

Urgency Incontinence treatment

Answer 5

Bladder retraining

behavioral modification

Question 6

Bladder sensation during office cystometrogram

Answer 6

Bladder sensation (1st sensation, 1st desire, normal desire,
strong desire, urgency

Question 7

Aspects of urodynamics

Answer 7

Part 1: Uroflow Study with PVR evaluation- 18 ml/sec is the cutoff

 Multichannel systems use two catheters:
 Vesical catheter with 1-2 pressure sensors
 Abdominal pressure catheter placed vaginally or rectally
 Direct measures:
 PVes: Direct measure of vesical pressure
 PAbd: Estimated measure of intra-abdominal pressure
 PUra: Direct measure of urethral pressure
 Indirect measures:
 PDet: Component of vesical pressure created by forces in
the bladder wall. Estimated by PVes – PAbd
 PClo: Pressure generated by urethral sphincter alone.
Estimated by PUra – PVes

Question 8

Diagnosis of ISD

Answer 8

Maximal urethral closure pressure is the difference
between the maximal Pura and Pves
 Diagnosis of ISD associated with MUCP < 20cm
H2O 14

Leak point pressure
 Measure of intrinsic sphincter strength
 Intravesical pressure at which urine leakage occurs due to
rise in abdominal pressure in the absence of detrusor
contraction
 LPP < 60 associated with ISD

these measurements do not reliably predict surgical outcome. Unclear how to use them

Question 9

Lifestyle modifications for urinary incontinence

Answer 9

Weight loss
 Smoking
 Physical forces
 Constipation
 Dietary factors
Alcohol - liquor, wine, beer
 Caffeine - coffee, tea, sodas, chocolate
 Very acidic fruits or juices - orange, grapefruit
 Tomatoes - juice, spaghetti sauce, pizza, chili
 Spicy foods - Mexican, Thai, Indian, Cajun
 Sugar - sweeteners, honey
 Fluid intake – volume, timing

behavioral training
Kegels (30-50 day)

Question 10

Contraindications to pessary use

Answer 10

Vaginal atrophy, infection, erosion, Non-compliance with care
 Sexually active women who cannot remove pessary

Question 11

Can you treat stress urinary incontinence with medications

Answer 11

none

Question 12

Medications for urge incontinence

Answer 12

Antimuscarinic - oxybutynin ER 5-30 mg daily
- must try for 4 weeks

Contraindications: urinary retention, gastric retention, narrow angle glaucoma, myasthenia, Dementia

Side effects: dry mouth, constipation, headache, dyspepsia, sedation, tachycardia, impaired voiding

Question 13

Sacral Nerve Stimulation use

Answer 13

For Urge Incontinence - 60-80% efficacy

Question 14

Percutaneous Tibial Nerve Stimulation

Answer 14

for Urge

Procedure
 Stimulation of posterior tibial nerve with acupuncture needle
 30 minutes weekly for 12 week course

 Results
 60-70% success with at least 50% decrease in symptoms
 RCT demonstrated comparable efficacy to tolterodine
 Office-based, safe, minimally invasive
 Duration of success unclear Incontinence

Question 15

Botox for urine leakage

Answer 15

Neurogenic Bladder

• 100 units for non-neurogenic

300 units for neurogenic

Reversible inhibition of pre-synaptic acetylcholine
release

Duration of effect varies from 3 to 12 months

 Significant clinical response in 60-90% of patients

Complications - urine retention, UTI

Question 16

Mirabegron

Answer 16

B3 receptor agonist

urge incontinence