Incontinence and prolapse

Question 1

define urinary incontinence

Answer 1

involuntary leakage of urine

Question 2

define stress urinary incontinence

Answer 2

involuntary leakage of urine after physical exertion e.g. coughing, sneezing, sports

Question 3

define urge urinary incontinence

Answer 3

overactive bladder
feeling of urgency
trying to make it to the toilet on time causing leakage

Question 4

define mixed urinary incontinence

Answer 4

features of both stress and urge urinary incontinence

Question 5

RF for incontinence

Answer 5

age 
BMI 
parity
menopause 
oestrogen deficiency 
hysterectomy 
UTI 
smoking 
FH 
caffeine
alcohol (diuretic)
DM

Question 6

urinary symptoms can be categorised into what?

Answer 6

storage symptoms

voiding symptoms

Question 7

list storage symptoms of UI

Answer 7

frequency 
nocturia 
urgency 
incontinence 
constant leakage

Question 8

list voiding symptoms of UI

Answer 8

difficulty getting started
dribbling 
hesitancy 
poor flow 
dysuria 
haematuria

Question 9

examination for UI

Answer 9

BMI
abdominal exam
PV exam
neuro (S2-4)

Question 10

investigations for UI

Answer 10

urinalysis 
post void bladder scanning 
bladder diary
cystoscopy 
urodynamics

Question 11

management of stress UI

Answer 11

Conservative:
weight loss 
smoking cessation 
pelvic floor exercises 
incontinence ring 
Medical: vaginal oestrogen, (duloxetine)
Surgical:
bulking agents, fascial slings, colposuspension

Question 12

mechanism of action of duloxetine

Answer 12

5HT and NA reuptake inhibitor

Question 13

Management of overactive bladder

Answer 13

Conservative:
weight loss, reduce caffeine, smoking cessation, bladder retraining
Medical: vaginal oestrogen, anti-cholinergics, B3-agonist, desmopressin
Surgical: botox, PPTNS, augmentation cytoplasty

Question 14

examples of anti-cholinergics used in OAB

Answer 14

tolterodine
solifenacin
oxybutynin

Question 15

side effects of anti-cholinergics

Answer 15

dry mouth and eyes
tachycardia
urinary retention
constipation

Question 16

example of B3 agonist used in OAB

Answer 16

mirabegron

Question 17

what is Pelvic Organ Prolapse POP?

Answer 17

herniation of pelvic or abdominal organs through the vaginal canal

Question 18

examples of POP

Answer 18

cystocele - anterior wall
rectocele - posterior wall
uterine prolapse
vaginal vault proplapse = top of the vagina post hysterectomy

Question 19

RF of POP

Answer 19

age
high parity
post menopausal - oestrogen deficiency
BMI
smoker - chronic cough
neurological conditions - spina bifida, muscular dystrophy
collagen disorders - Marfans, Ehler-Danlos

Question 20

symptoms of POP

Answer 20

heaviness 
sensation of dragging 
urinary frequency, urgency, incomplete voiding
manual reduction of prolapse 
faecal incontinence 
straining 
sexual dysfunction

Question 21

examination for POP

Answer 21

abdo and PV exam

Question 22

system to classify POP

Answer 22

POP-Q classification system

Question 23

management of POP

Answer 23

conservative: lifestyle advice, pelvic floor exercises, vaginal oestrogen
Pessaries
surgery

Question 24

describe the POP-Q classification

Answer 24

uses the hymen as a landmark reference and defines 6 points (2 in each vaginal compartment - ant/superior/post)

Question 25

describe stage 0 prolapse

Answer 25

no prolapse demonstrated

Question 26

describe stage 1 prolapse

Answer 26

leading edge is -1cm or above | mild protrusion

Question 27

describe stage 2 prolapse

Answer 27

leading edge is between -1cm and +1cm | present at introitus

Question 28

describe stage 3 prolapse

Answer 28

leading edge is +1cm or below but without complete eversion | protruding outside introitus

Question 29

describe stage 4 prolapse

Answer 29

complete vaginal eversion aka procidentia complete prolapse

Question 30

complications of longterm use of vaginal pessaries

Answer 30

vaginal discharge ulceration --> fistulae fibrous band formation

Question 31

how often should pessaries be changed and why

Answer 31

every 6 months with the additional use of topical oestrogen | to prevent fistula formation

Question 32

side effects of duloxetine

Answer 32

``` difficulty sleeping headaches dizziness blurred vision CIBH N+V dry mouth sweating decreased appetite decreased libido ```

Question 33

bladder diary features

Answer 33

``` number of pads volume of urine passed w = wet x = bowel motion p = changed a pad nocturia ```

Question 34

indication for urodynamics

Answer 34

prior to surgical options | to ensure correct diagnosis

Question 35

in stress incontinence, forget medical management, true or false

Answer 35

true | duloxetine is reserved as a very last line option

Question 36

___ is harvested for fascial slings in surgical management of stress UI

Answer 36

rectus sheath

Question 37

OAB vs urge UI

Answer 37

urge UI - they actually leak | OAB - don't know if they are actually incontinent

Question 38

why is oxybutynin not used as commonly

Answer 38

can worsen cognitive function | oxybutynin is the worst anticholinergic for this

Question 39

side effects of mirabegron that need monitoring

Answer 39

BP

Question 40

for overactive bladder, you can forget about surgical management, true or false

Answer 40

true | botox is the only thing

Question 41

what is bladder pain syndrome

Answer 41

diagnosis of exclusion | chronic pain syndrome

Question 42

long term definitive management of POP

Answer 42

``` surgery: anterior/posterior repair sacrospinous fixation colpoplexy colpocleisis - vaginal closing procedure (not fully in case of PMB) ```

Question 43

management of POP

Answer 43

conservative - lifestyle advice, pelvic floor exercises, vaginal oestrogen pessaries surgery -

Question 44

can you have sexual intercourse with pessaries

Answer 44

no, except for 1 type - self managed cube pessary