Urinary incontinence

Question 1

What types of urinary incontinence are there and their features

Answer 1

Stress- cough or sneeze-> leakage
Urge - when urge hits get leakage

mixed incontinence: both urge and stress
overflow incontinence: due to bladder outlet obstruction, e.g. due to prostate enlargement
functional incontinence
comorbid physical conditions impair the patient’s ability to get to a bathroom in time
causes include dementia, sedating medication and injury/illness resulting in decreased ambulation

Question 2

First line for stress incontinence

Answer 2

Lifestyle - loose weight, less caffeine
Pelvic floor exercises - 8 contractions 3 times a day

Question 3

Surgery for stress incontinence

Answer 3

Mid urethral tape procedures
intramural bulking agent injections
colposuspension

Question 4

Who is offered duloxetine for stress incontinenxe

Answer 4

Decline surgery

Question 5

What add with duloxetine

Answer 5

SNRI or SSRI

Question 6

MOA duloxetine

Answer 6

increased synaptic concentration of noradrenaline and serotonin within the pudendal nerve → increased stimulation of urethral striated muscles within the sphincter → enhanced contraction

Question 7

Risk factors for incontinence

Answer 7

advancing age
previous pregnancy and childbirth
high body mass index
hysterectomy
family history

Question 8

Investigations for incontinence

Answer 8

3 days bladder diaries
Vaginal exam - test pelvic muscles and look for prolapse
Urine dip and culture
Urodynamic studies if uncertain, mixed or surgical intervention planned

Question 9

First line urge incontinence

Answer 9

Bladder retraining - 6 weeks minimum
Antimuscarinics - oxybutinin, tolerotidine, darifenacin, solifenacin as alternative

Question 10

What give if nocturia problem in urge incontinence

Answer 10

Desmopressin

Question 11

Alternative for anticholinergic antimuscarinics in incontinence egf elderly

Answer 11

Mirabegon - beta 3 agonist

Question 12

What drug avoid in elderly falls risk patients

Answer 12

Oxybutinin

Question 13

When offer botulinum toxin type A bladder wall injection for incontinence

Answer 13

if urodynamic investigations determine that detrusor overactivity is causing her overactive bladder symptom