Female urinary incontinence

Question 1

Describe the innervation of the urethral sphincters.

Answer 1

Pudendal nerve
S2-S4 somatic
Voluntnary

Question 2

What are the keys to bladder emptying?

Answer 2

Detrusor contraction
Urethral relaxation
Sphincter co-ordination
Absence of obstruction or anatomical shunts

Question 3

What is urinary incontincence?

Answer 3

Any involuntary leakage of urine

Question 4

What is SUI?

Answer 4

Stress urinary incontinence

Involuntary leakage on effort or exertion including sneezing or coughing

Question 5

What is UUI?

Answer 5

Urge urinary incontinence

Involuntary leakage accompanied by urgency

Question 6

What are some consequences of UI?

Answer 6

Reduce social relationships
Emotional and psychological damage
Impair sexual relationships
Embarrassment and diminished self-esteem

Question 7

What are some risk factors for female urinary incontinence?

Answer 7

Age 
Parity
Menopause
Smoking
Pelvic floor trauma
Denervation
Connective tissue disease
Surgery

Question 8

What kind of medications could be a risk factor for urinary incontinence?

Answer 8

Anti-hypertensives
Anti-depressants
Anti-psychotics

Question 9

What are some conditions which could pre-dispose a patient to urinary incontinence?

Answer 9

DM
Glaucoma
Heart/kidney/liver problems
Previous PFMT

Question 10

How could you asses the effect of urinary incontinence on QoL?

Answer 10

“How much does Urinary leakage interfere with your day to day activities?”

Question 11

What factors would a 3 day urinary diary include?

Answer 11

Fluid intake (quality and quantity)
Urine output
Daytime frequency
Nocturia
Average voided volume

Question 12

What are some considerations in the examination of the women with bladder/ pelvic floor problems?

Answer 12

Prolapse
Stress incontinence
Uro-genital atrophy changes 
Pelvic mass (space occupying lesion)
Pelvic floor tone, strength, awareness

Question 13

What are some useful investigation for bladder/ pelvic floor problems?

Answer 13

Urinalysis
Post voiding residual volume assessment
USS

Question 14

How is PDet calculated?

Answer 14

On cystometry result

PAbd subtracted from PVes

Question 15

Are there any medical solutions to SUI?

Answer 15

Duloxetine

Approved for restricted use for moderate to severe SUI

Question 16

Why may duloxetine be prescribed?

Answer 16

If PFMT has failed or would be enhanced
Patient does not want
surgery
Failed surgery

Question 17

What is TVT?

Answer 17

Tension-free vaginal tape

Minimally invasive procedure to reinforce the structures supporting the urethra

Question 18

Is TVT as effective as colposuspension?

Answer 18

Yes

Question 19

What is OAB?

Answer 19

Overactive bladder syndrome

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

Question 20

What are some common risk factors for urge incontinence?

Answer 20

Advanced age
Diabetes
UTI
Smoking

Question 21

What are some useful lifestyle interventions for OAB management?

Answer 21

Normalise fluid intake
Reduce caffeine, fizzy drinks, chocolate
Stop smoking
Weight loss

Question 22

What is bladder retraining?

Answer 22

The re-establishment of cortical control over detrusor function and voiding
Achieved by timed bladder emptying programme

Question 23

What kinds of drugs could be used to treat OAB?

Answer 23

Antimuscarinic

Tri-cyclic antidepressants

Question 24

What are some benefits of neuromodulation to treat OAB?

Answer 24

Cheap
Minimally invasive
70% improvement in Refractory OAB