Stress Urinary Incontinence — MCQs

10 questions

All of the following drugs are used for the treatment of urinary incontinence except:

A 70-year-old woman complains of leaking urine in small amounts, which occurs when laughing, coughing, bending, or exercising. Her five children are concerned about her urinary problems. Which is the most likely type of urinary incontinence?

A one-year-old male child presented with a poor urinary stream since birth. The initial investigation of choice for evaluation is:

Risk factors for stress urinary incontinence are all except

An elderly female presented with dribbling of urine only on coughing and straining. What type of urinary incontinence is she suffering from

All of the following surgeries are done in SUI except

Kegel's exercises should begin after?

3 pad test is done for:

With reference to the displacement of uterus, the treatment of choice for genuine stress urinary incontinence is:

Q10

Which of the following accurately describes management of Grade 3 pelvic organ prolapse in an elderly woman who is a poor surgical candidate?

Stress Urinary Incontinence Indian Medical PG Practice Questions and MCQs

Question 1: All of the following drugs are used for the treatment of urinary incontinence except:

A. Ipratropium (Correct Answer)
B. Oxybutynin
C. Tolterodine
D. Darifenacin

Explanation: ***Ipratropium*** - **Ipratropium** is a short-acting muscarinic antagonist primarily used as a **bronchodilator** in obstructive lung diseases. - While it has anticholinergic properties, it is not typically used for **urinary incontinence** due to its limited systemic absorption and short duration of action, making it less effective for bladder control compared to other agents. *Oxybutynin* - **Oxybutynin** is a commonly prescribed **muscarinic antagonist** that acts by relaxing the bladder detrusor muscle, increasing bladder capacity and reducing involuntary contractions. - It is effective in treating **overactive bladder** and urge incontinence. *Tolterodine* - **Tolterodine** is a **muscarinic receptor antagonist** that specifically targets M2 and M3 receptors in the bladder, reducing bladder hyperreactivity. - It is used for the symptomatic treatment of **urge incontinence** and overactive bladder. *Darifenacin* - **Darifenacin** is a highly M3-selective muscarinic receptor antagonist, which means it primarily blocks the M3 receptors responsible for **detrusor muscle contraction**. - Its selectivity helps minimize side effects common to less selective anticholinergics and is used for the treatment of **overactive bladder** with symptoms of urgency, frequency, and urge incontinence.

Question 2: A 70-year-old woman complains of leaking urine in small amounts, which occurs when laughing, coughing, bending, or exercising. Her five children are concerned about her urinary problems. Which is the most likely type of urinary incontinence?

A. Stress incontinence (Correct Answer)
B. Urge incontinence
C. Overflow incontinence
D. Functional incontinence

Explanation: ***Stress incontinence*** - This is characterized by the involuntary leakage of urine with activities that increase **intra-abdominal pressure**, such as **coughing, sneezing, laughing, bending, or exercising**. - It commonly results from **weakness of the pelvic floor muscles** or dysfunction of the urethral sphincter, often due to childbirth or aging. *Urge incontinence* - This involves a sudden, **intense urge to urinate** followed by involuntary loss of urine, often without any precipitating activity. - It is typically caused by **detrusor overactivity**, where the bladder muscles contract involuntarily. *Overflow incontinence* - This occurs when the bladder is **overfilled** and urine leaks out, often in small amounts, because the bladder cannot empty properly. [1] - It can be caused by **bladder outlet obstruction** (e.g., enlarged prostate in men) or impaired detrusor contractility (e.g., neurological conditions). [1] *Functional incontinence* - This refers to urine leakage that occurs because of **physical or cognitive impairments** that prevent a person from reaching the toilet in time. [1] - The urinary tract itself may be normal, but external factors limit effective toileting. [1]

Question 3: A one-year-old male child presented with a poor urinary stream since birth. The initial investigation of choice for evaluation is:

A. USG bladder
B. Voiding cystourethrography (VCUG) (Correct Answer)
C. Uroflowmetry
D. Intravenous urography

Explanation: ***Voiding cystourethrography (VCUG)*** - A **one-year-old male child with poor urinary stream since birth** is highly suggestive of **posterior urethral valves (PUV)**, the most common cause of bladder outlet obstruction in male infants. - **VCUG is the investigation of choice** for diagnosing PUV as it directly visualizes the posterior urethra during voiding and can demonstrate the characteristic findings: dilated posterior urethra, valve leaflets, bladder trabeculation, and vesicoureteral reflux. - While it involves catheterization and radiation, in this classic presentation, VCUG provides definitive diagnosis and is essential for surgical planning. *USG bladder* - Ultrasound is a useful **non-invasive screening tool** that can detect secondary findings such as hydronephrosis, bladder wall thickening, and increased post-void residual. - However, **USG cannot visualize the urethral valves** themselves and cannot definitively diagnose PUV. - In practice, many centers may perform ultrasound first, but it must be followed by VCUG for definitive diagnosis in this clinical scenario. *Uroflowmetry* - This test measures the **rate of urine flow** and requires patient cooperation with voiding. - A **one-year-old child cannot reliably follow instructions** to perform uroflowmetry. - It is more useful in older, cooperative children and adults. *Intravenous urography* - **Intravenous urography (IVU)** involves contrast administration and multiple X-rays to visualize the urinary tract. - It has been largely **replaced by ultrasound and CT urography** due to better imaging quality and safety profile. - IVU does not adequately visualize the urethra or diagnose urethral pathology like PUV.

Question 4: Risk factors for stress urinary incontinence are all except

A. Obesity
B. Hypertension (Correct Answer)
C. Smoking
D. Pregnancy

Explanation: ***Hypertension*** - While hypertension is a significant health concern, it is **not directly a recognized risk factor** for stress urinary incontinence. - Risk factors for stress urinary incontinence primarily involve factors that increase **intra-abdominal pressure** or weaken pelvic floor support. *Obesity* - **Increased intra-abdominal pressure** due to excess weight places constant strain on the pelvic floor muscles and urethral sphincter. - This persistent pressure can lead to weakening of the supporting structures, predisposing to **stress urinary incontinence**. *Smoking* - Smoking is associated with chronic cough, which repeatedly increases **intra-abdominal pressure**, potentially leading to pelvic floor muscle weakness. - It also affects **collagen synthesis**, which can weaken connective tissues supporting the bladder and urethra. *Pregnancy* - The growing uterus during pregnancy places significant **mechanical stress** on the pelvic floor muscles and ligaments. - **Hormonal changes** during pregnancy can also relax connective tissues, further contributing to pelvic floor laxity.

Question 5: An elderly female presented with dribbling of urine only on coughing and straining. What type of urinary incontinence is she suffering from

A. Overflow incontinence
B. Stress incontinence (Correct Answer)
C. Urge incontinence
D. Neurogenic bladder

Explanation: ***Stress incontinence*** - **Dribbling of urine** specifically with activities that increase intra-abdominal pressure like **coughing or straining** is the hallmark of stress incontinence. - This type of incontinence results from **weakness of the pelvic floor muscles** and/or intrinsic urethral sphincter deficiency. *Overflow incontinence* - This occurs when the bladder is **overfilled and unable to empty**, leading to constant dribbling or leakage. - Patients typically experience a **poor stream**, hesitancy, and a feeling of incomplete emptying, which are not described here. *Urge incontinence* - Characterized by a **sudden, strong urge to urinate** that is difficult to defer, often leading to involuntary leakage before reaching the toilet. - It is caused by **involuntary contractions of the detrusor muscle** and is not directly related to physical exertion like coughing. *Neurogenic bladder* - This refers to bladder dysfunction due to a **neurological condition** affecting bladder control, such as spinal cord injury or multiple sclerosis. - Symptoms can vary broadly (flaccid or spastic bladder) and are not limited to leakage with coughing alone.

Question 6: All of the following surgeries are done in SUI except

A. Aldridge sling
B. Shirodkar sling (Correct Answer)
C. Kelly's stitch
D. Marshall Marchetti Krantz

Explanation: ***Shirodkar sling*** - The **Shirodkar sling** procedure is primarily used for the treatment of **cervical incompetence** in pregnancy, not stress urinary incontinence (SUI). - It involves placing a **cerclage** (suture) around the cervix to reinforce it and prevent preterm birth. *Aldridge sling* - The **Aldridge sling** is a type of **pubovaginal sling**, which is a surgical procedure used to treat SUI. - It involves using a **fascial sling** (often autologous) to support the bladder neck and urethra, increasing outlet resistance. *Kelly's stitch* - **Kelly's stitch**, also known as the **Kelly plication**, is a historical procedure for SUI that involves approximating the **periurethral tissues** anterior to the urethra. - While less common today as a standalone procedure, it aimed to reinforce the bladder neck and improve urethral coaptation. *Marshall Marchetti Krantz* - The **Marshall-Marchetti-Krantz (MMK) procedure** is a well-established **retropubic urethropexy** used for SUI. - It involves suturing the **periurethral tissues** to the **pubic bone** to elevate and stabilize the bladder neck and proximal urethra.

Question 7: Kegel's exercises should begin after?

A. 24 hours after delivery
B. 3 weeks after delivery
C. 6 weeks after delivery
D. Immediately after delivery (Correct Answer)

Explanation: ***Immediately after delivery*** - **Kegel's exercises** can be initiated as soon as possible after delivery, provided the woman feels comfortable and there are no contraindications. - Early commencement helps **restore pelvic floor muscle tone**, reduce urinary incontinence, and promote healing. *24 hours after delivery* - While it is not strictly incorrect to start at 24 hours, waiting unnecessarily delays the potential benefits of **pelvic floor muscle training** for postpartum recovery. - The goal is to start as early as comfort allows, which can often be within the first few hours. *3 weeks after delivery* - Waiting three weeks to begin **Kegel's exercises** would be a significant delay in postpartum recovery. - Early engagement is crucial for **optimal rehabilitation** of the pelvic floor and prevention of long-term issues. *6 weeks after delivery* - Six weeks after delivery is typically the time for the **postpartum check-up**, but it is too late to *begin* Kegel's exercises for optimal benefit. - By this point, opportunities for **early muscle re-education** and symptom prevention would have been missed.

Question 8: 3 pad test is done for:

A. Rectovaginal fistula
B. Urethrocoele
C. Stress incontinence (Correct Answer)
D. Urinary fistula

Explanation: ***Stress incontinence*** - The **3-pad test (pad weighing test)** is a standardized, objective method to **quantify urinary incontinence**, particularly stress incontinence - The test involves weighing absorbent pads before and after a specified period (1-hour test or 24-hour test) to measure the exact amount of urine leakage - **Stress incontinence** is the most common indication, where involuntary urine leakage occurs during activities that increase intra-abdominal pressure (coughing, sneezing, laughing, exercise) - The test helps **grade severity** (mild <50g, moderate 50-100g, severe >100g) and **monitor treatment response** - It provides objective documentation of incontinence severity for clinical decision-making *Urinary fistula* - A urinary fistula is an abnormal communication between the urinary tract and another structure (vesicovaginal, ureterovaginal fistula) - While severe continuous leakage occurs, diagnosis is made by **clinical examination**, **dye tests** (methylene blue test, double dye test), **speculum examination**, and **imaging** (cystoscopy, IVP) - The pad test is not the primary diagnostic method for fistulas, though it may show continuous heavy leakage *Rectovaginal fistula* - This is an abnormal connection between the rectum and vagina, causing passage of stool or gas through the vagina - The 3-pad test specifically measures **urine loss**, not fecal incontinence - Not relevant for rectovaginal fistula assessment *Urethrocoele* - A urethrocoele is a herniation or prolapse of the urethra into the anterior vaginal wall - This is a **structural/anatomical diagnosis** made by pelvic examination - While patients may have associated stress incontinence, the pad test measures the leakage, not the anatomical defect itself - Diagnosis is clinical, not based on pad testing

Question 9: With reference to the displacement of uterus, the treatment of choice for genuine stress urinary incontinence is:

A. Periurethral injection of bulking agents
B. Kegel’s perineal exercises
C. TVT‐O mid urethral tape (Correct Answer)
D. Kelly's plication

Explanation: ***TVT‐O mid urethral tape*** - **TVT-O (tension-free vaginal tape-obturator)** is a minimally invasive surgical procedure that provides support to the mid-urethra, effectively treating genuine **stress urinary incontinence (SUI)**. - This procedure aims to restore the anatomical support mechanisms of the urethra, preventing urine leakage during activities that increase abdominal pressure. *Periurethral injection of bulking agents* - This method involves injecting materials around the urethra to increase its bulk and improve coaptation, but it is generally reserved for patients who are not suitable for surgery or as a secondary treatment, and typically has **lower long-term success rates** compared to tape procedures. - While it can improve continence in some cases, it addresses the issue by increasing urethral resistance rather than restoring proper anatomical support. *Kegel’s perineal exercises* - **Kegel exercises** aim to strengthen the **pelvic floor muscles**, which can be effective for mild SUI by improving urethral support and sphincter function. - However, for genuine SUI, which often involves significant anatomical changes or urethral hypermobility, these exercises are typically used as a **first-line conservative treatment** and may not be sufficient on their own. *Kelly’s plication* - **Kelly's plication**, also known as the **Kelly stitch**, is an older surgical procedure that involves plicating (folding and suturing) the periurethral fascia to provide urethral support. - This procedure has largely been replaced by more effective and less invasive mid-urethral tape procedures like TVT-O due to **higher failure rates** and potential complications.

Question 10: Which of the following accurately describes management of Grade 3 pelvic organ prolapse in an elderly woman who is a poor surgical candidate?

A. Bladder sling
B. Vaginal hysterectomy
C. Pessary placement (Correct Answer)
D. Kegel exercises

Explanation: ***Pessary placement*** - **Pessaries** are a less invasive, effective option for **pelvic organ prolapse** management in patients who are **poor surgical candidates**, helping to support prolapsed organs. - They also serve as a good temporary option to improve symptoms before surgical intervention. *Bladder sling* - A **bladder sling** is a surgical procedure used primarily to treat **stress urinary incontinence**, not pelvic organ prolapse. - This option is unsuitable for a patient who is a **poor surgical candidate**. *Vaginal hysterectomy* - A **vaginal hysterectomy** involves surgical removal of the uterus through the vagina, which is a definitive treatment for **uterine prolapse**. - However, surgical interventions are contraindicated for an **elderly woman** who is a **poor surgical candidate** due to potential risks. *Kegel exercises* - **Kegel exercises** are beneficial for strengthening the **pelvic floor muscles** and preventing the progression of early-stage prolapse or improving mild symptoms. - However, they are generally **insufficient** for managing **Grade 3 pelvic organ prolapse**, which requires more robust support.

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