ICB - Incontinence

Question 1

What is stress incontinence? What investigations would you perform? Outline the management

Answer 1

-Leaking small amounts of urine when coughing or laughing

Investigations:

• MSU
• Abdo exam
• Post void bladder scan
• Genitalia exam (atrophic vaginitis/prolapse)

Management:

• Pelvic floor exercises (8 contracts TDS for 3/12)
• Surgery: retropubic mid urethral tape procedures

Question 2

What is urge incontinence/OAB? What investigations would you perform?

Answer 2

-Once desire to pee is felt, the patient can’t resist (toilet mapping) - due to detrusor over-activity

Investigations:

• Routine: bladder diary (3 days), PV exam, urine dip and MSU
• Urodynamics

Question 3

Outline the management of OAB/urge incontinence

Answer 3

Management

• Bladder training: minimum 6 weeks
• Improving oral intake of fluids
• Reduce caffeine consumption
• Anti-muscarinics: oxybutynin (immediate release but avoid in older frail pts), tolterodine, mirabegron (better in older/frail patients)

Question 4

What is overflow incontinence? Investigations and management?

Answer 4

-Obstruction causing retention and then leakage of urine - small continuous dribble (due to bladder outlet ouflow - eg in BPH)

Investigations

• Bladder scan
• R/w causes of retention: PR, abdo exam

Management
Relieve obstruction: eg laxatives or BPH mx

Question 5

What is functional incontinence? Investigations? Management?

Answer 5

-Incontinence on the way to the bathroom - something obstructing the way

Investigations:
-Rule out other causes for recention/incontinence and check home environment

Management
-Change home set up - eg toilet closer to bed

Question 6

What is mixed incontinence?

Answer 6

Urge and stress incontinence

Question 7

Oxybutynin: class of drug, indications for use and side effects

Answer 7

• Anti-muscarinic
• Indication: urge incontinence,frequnecy, urgency, neurogenic bladder instability
• SEs: constipation, dizziness, drowsiness and dry mouth

Question 8

Mirabegron: class of drug, indications for use and side effects

Answer 8

-B3 adrenergic agonist
-Indication: urge incontinence, frequnecy, urgency
-SEs: arrhythmias, constipation, dizziness, diarrhoea, headache
*Used preferentially in older patients with UI in order to spare them anti-cholinergic burden

Question 9

Tolteradine: class of drug, indications for use and side effects

Answer 9

• Antimuscarinic
• Use: UI, frequnecy, urgency, neurogenic bladder instability
• SEs: constipation, dizziness, drowsiness and dry mouth

Question 10

Tamsulosin: class of drug, indications for use and side effects

Answer 10

• Alpha 1 adrenoreceptor antagonist
• Use: BPH urinary outflow obstruction
• SEs: dizziness, sexual dysfunction/ejaculation issues

Question 11

Doxazosin: class of drug, indications for use and side effects

Answer 11

• Alpha 1 adrenergic blockers
• Use: BPH urinary outflow obstruction (improves peak urinary flow), HTN
• SEs: arrhythmias, dizziness, cystitis

Question 12

Finasteride: class of drug, indications for use and side effects

Answer 12

• 5 alpha reductase inhibitors - blocks testosterone production (which stimulates prostate and causes BPH)
• Use: BPH
• SEs: impotence, loss of libido, dizziness