Urinary incontinance

Question 1

Overactive bladder syndrome symptoms

Answer 1

Nocturia
Increased frequency
Increased urgency that may/may not be associated with urinary incontinence.

Question 2

Define stress incontinence

Answer 2

Usually associated with loss of pelvic floor muscles/ urethral spinchter control.

Leakage can occur with sneezing/ coughing/ exertion

Question 3

1st line for stress incontinence?

Answer 3

Pelvic floor exercised fro 3 months minimum (8 contractions TDS minimally)

Question 4

2nd line therapy for stress incontinence or if pharmacolgoical therapy preferred?

Answer 4

Duloxetine (but should not be routinely offered)

Question 5

Which drugs can increase the risk of stress incontinence?

Answer 5

Alpha blockers (relax bladder outlet) and ACE inhibitors (if experiencing dry cough)

Question 6

Definition of urinary incontinence?

Answer 6

Involuntary leakage followed by sudden urge to pass urine that is difficult to delay

Question 7

1st line treatment for urgency incontinence?

Answer 7

6 weeks of bladder training

Question 8

Non-pharmacological advice to patients with incontinence?

Answer 8

Reduce caffeine intake

Reduce BMI if >30 in women

Reduce fluid intake

Question 9

Red flags needing referral for women presenting with urinary incontinence

Answer 9

Visible haematuria >45 years old with no associated infection.

Persistent haematuria despite successful treatment of UTI/ recurrent UTI.

Recurrent/persistent UTI > 60 years old.

Palpable bladder after voiding/ symptoms of trouble voiding

Pelvic mass

Associated faecal incontinence

Persistent bladder or urethral pain

Previous pelvic cancer surgery/radiation therapy.

Question 10

2nd line pharmacological treatment options for urgency incontinence?

Answer 10

Mirabegron

Question 11

Drug used for urgency incontinence that prolongs the QT?

Answer 11

Mirabegron

Question 12

Renal cut-off for reduced dose of mirabegron (25mg OD) ?

Answer 12

<30ml/min

Question 13

CI of mirabegron

Answer 13

Uncontrolled hypertension >180/110mmHg

Question 14

Advice regarding contraception in someone starting mirabegron?

Answer 14

Contraception advised

Question 15

Anticholinergic side effects

Answer 15

Tachycardia
Flushing/overheating- unable to sweat
Constipation
Urinary retention
Constipation
Blurred vision/ dry eyes
Drowsiness/ hallucination/ confusion/ dizziness
Dry mouth

Question 16

Treatment for mixed incontinence?

Answer 16

Treat predominant type of incontinence

Question 17

Mixed incontinence definition

Answer 17

Stress + Urgency

Question 18

Overflow incontinence definition

Answer 18

Chronic form of urinary retention- bladder cannot empty properly and becomes overflowed/distended

Question 19

Treatment for vaginal prolapse in a woman presenting with prolapse + atrophy?

Answer 19

Vaginal oestrogen

Question 20

Treatment for vaginal prolapse in a woman presenting with prolapse and a PMH including cognitive impairment?

Answer 20

Oestrogen vaginal ring

Question 21

Nocturnal enuresis definition

Answer 21

Involuntary urination at night usually in children

Question 22

What age is treatment for nocturnal enuresis usually recommended in children?

Answer 22

> 7 years

Question 23

What age can desmopressin be used in in children?

Answer 23

> 5 years

Question 24

1st line treatment for nocturnal enuresis in children?

Answer 24

Desmopressin

Question 25

Patient/ carer advice when starting desmopressin?

Answer 25

Avoiding fluid overload Restrict fluid 1 hour before and 8 hours after administration

Question 26

Type of convulsions associated with desmopressin

Answer 26

Hyponatraemic convulsions

Question 27

What can be initiated under specialist supervision for nocturnal enuresis 2nd line?

Answer 27

Oxybutynin / Tolteridone for 2 months

Question 28

What can be initiated under specialist supervision for nocturnal enuresis 3rd line?

Answer 28

Imipramine