Urinary Incontinence

Question 1

What organs are in the upper urinary tract?

Answer 1

Kidneys and ureters.

Question 2

What organs are in the lower urinary tract?

Answer 2

Bladder and urethra.

Question 3

Which nerves are for sympathetic (storage) of bladder?

Answer 3

T10-L2

Contraction of urethra
Relaxation of the bladder

Question 4

Which nerves are for parasympathetic (voiding) of the bladder?

Answer 4

S2-S4

Contraction of bladder
Relaxation of urethra

Question 5

Which nerve controls voluntary contraction and relaxation of the urethra?

Answer 5

Pudendal nerve - contracts to hold in urine.

Question 6

Which higher centre controls micturition?

Answer 6

The Pons - The pontine micturition centre - prevents micturition even against a full bladder.

Question 6

Which higher centre controls micturition?

Answer 6

The pontine micturition centre - controls sympathetic, parasympathetic pathways.

Question 7

What is stress incontinence?

Answer 7

Involuntary leakage on effort or exertion (increased abdominal pressure).

Question 8

What is urge incontinence?

Answer 8

Also known as overactive bladder.
Involuntary leakage accompanied by or just after the sense of urgency.

Question 9

What is mixed urinary incontinence?

Answer 9

Urge incontinence and stress incontinence.

Question 10

What is mixed urinary incontinence?

Answer 10

Urge incontinence and stress incontinence.

Question 11

Which incontinence is most common in younger people <30?

Answer 11

urge incontinence

Question 12

Which incontinence is most common in older people >30?

Answer 12

Stress incontinence.

Question 13

Which incontinence is most common in older people >30?

Answer 13

Stress incontinence.

Question 14

What are the risk factors for urge incontinence?

Answer 14

Recurrent UTI
High BMI
Older
Smoking
Caffeine

Question 15

What are the risk factors for stress incontinence?

Answer 15

Surgery (hysterectomy)
Pregnancy
Childbirth - especially vaginal delivery (denervation of nerves and damage)
Increased intra abdominal pressure

Question 16

What are the most important risk factors of stress incontinence?

Answer 16

Pregnancy and childbirth.

Question 17

What are the contraindications for oxybutynin?

Answer 17

>65yrs (women)
Anti-depressants
Anti-psychotics
Glaucoma

Question 18

What is the role of antimsucarinic medication in urinary incontinence?

Answer 18

Acetylcholine is the primary neurotransmitter which binds to receptors on the detrusor muscle causing contraction. Anticholinergics help inhibit this.

Question 19

How many times should someone pee during the night?

Answer 19

Increases by 1 for each decade starting at 60yrs.

70yrs - 2x.
80yrs - 3x.

Question 20

What investigations should be done for urinary incontinence?

Answer 20

Urine dipstick - to exclude UTI.
Post voiding residual volume assessment.
3 day urinary diary
Urodynamics - ONLY if surgery is contemplated

Question 21

How can menopause cause incontinence?

Answer 21

Lack of oestrogen causes urogenital atrophy.

Question 22

What is the first line of management for all urinary incontinence?

Answer 22

Conservative - avoid caffeine, sugar, fizzy drinks, too much to drink, alcohol.

+ Pelvic floor exercises.

Stop smoking
lose weight
avoid constipation/chronic cough etc.

Question 23

What is the Oxford score?

Answer 23

This is assessed during vaginal palpation.

0 - no pelvic floor muscle strength

4 - a good pelvic floor muscle strength

5- strong pelvic floor muscle strength

Question 24

What is the only medication used to manage stress incontinence?

Answer 24

Duloxetine. Used when - conservative management fails AND patient is not a candidate for surgery.

Question 25

What is the surgical management of urinary stress incontinence?

Answer 25

MID URETHRAL SLING/TVT - gold standard. Colposuspension and fascia slings (lower part of the vagina is stitched to a ligament behind the pubic bone to decrease transmission pressure and compression) Bulking agents into bladder neck.

Question 26

What is the medical treatment for urge incontinence/OAB?

Answer 26

Anticholinergics (inhibit parasympathetic activity on detrusor muscle) - oxybutynin, tolterodine, **Fesoterodine, Solifenacin**

Question 27

What is the surgical treatment for urge incontinence?

Answer 27

Botox injection - to paralyse detrusor muscle. sacral nerve modulation.

Question 28

What is urgency?

Answer 28

Sudden desire to pass urine that's difficult to defer.

Question 29

What is urge incontinence?

Answer 29

Involuntary leakage that has urgency before or during it.

Question 30

What is frequency\>

Answer 30

Usually accompanies urgency (with or without incontinence) - when the patient complains they void too often \>7x.

Question 31

What is noctirua\>

Answer 31

When the individual has to wake at night one or more times to void - accompanies urgency with or without urge incontinence.

Question 32

What is a treatment for over active bladder?

Answer 32

Bladder retraining - increasing the time before going to the toilet. Antimuscarinics. Tri-cyclic antis depressants - imipramine.

Question 33

Where is sacral neuromodulation targeted?

Answer 33

S2-S4.