Gynae: Urogynae

Question 1

Classification of incontinence?

Answer 1

• Overactive bladder (OAB)/urge incontinence: due to detrusor overactivity
• Stress incontinence: leaking small amounts when coughing or laughing
• Mixed incontinence: both urge and stress
• Overflow incontinence: due to bladder outlet obstruction, e.g. due to prostate enlargement

Question 2

Incontinence: Investigations?

Answer 2

• Bladder diaries should be completed for a minimum of 3 days
• Vaginal examination to exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles (‘Kegel’ exercises)
• Urine dipstick and culture
• Urodynamic studies