Urinary Incontinence: Classification — MCQs

10 questions

A 50-year old woman complains of leakage of urine. Other than genuine stress urinary incontinence, the most common cause of urinary leakage is ?

In a case of incontinence of urine, dye filled into the urinary bladder does not stain the pad in the vagina, yet the pad is soaked with clear urine. Most likely diagnosis is:

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?

Which urinary bladder spasmolytic has local anesthetic properties?

Which of the following statements is MOST accurate regarding stress incontinence?

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

All of the following surgeries are done in SUI except

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

Risk factors for stress urinary incontinence are all except

Q10

Urinary incontinence in uterovaginal prolapse is mostly due to:

Urinary Incontinence: Classification Indian Medical PG Practice Questions and MCQs

Question 1: A 50-year old woman complains of leakage of urine. Other than genuine stress urinary incontinence, the most common cause of urinary leakage is ?

A. Vesico vaginal fistula
B. Overflow incontinence
C. Detrusor dyssynergia
D. Urge incontinence (Correct Answer)

Explanation: ***Urge incontinence*** - **Urge incontinence**, characterized by an **involuntary leakage of urine accompanied or immediately preceded by urgency**, is the most common form of urinary incontinence after stress urinary incontinence, especially in older women [1]. - It results from **detrusor overactivity**, leading to sudden, strong urges to void that are difficult to defer. *Vesico vaginal fistula* - A **vesicovaginal fistula** involves an abnormal connection between the bladder and the vagina, leading to continuous and spontaneous leakage of urine into the vagina, which would present differently from typical urge symptoms [1]. - While it causes leakage, it's a relatively rare cause compared to urge incontinence and is often associated with prior surgery or radiation. *Overflow incontinence* - **Overflow incontinence** occurs when the bladder is overfilled and unable to empty properly, leading to continuous leakage of small amounts of urine due to retention [1]. - This is often caused by **bladder outlet obstruction** or **neurogenic bladder**, and the patient might report difficulty voiding or a sensation of incomplete emptying [1]. *Detrusor dyssynergia* - **Detrusor dyssynergia** describes a lack of coordination between the detrusor muscle contraction and external urethral sphincter relaxation, typically seen in neurological disorders [2]. - This condition is a specific type of voiding dysfunction that can lead to incontinence but is not the most common cause of leakage after stress incontinence in the general population.

Question 2: In a case of incontinence of urine, dye filled into the urinary bladder does not stain the pad in the vagina, yet the pad is soaked with clear urine. Most likely diagnosis is:

A. VVF
B. Urethrovaginal fistula
C. Ureterovaginal fistula (Correct Answer)
D. Urinary stress incontinence

Explanation: **Ureterovaginal fistula** - If a **dye-filled bladder** does not stain the vaginal pad but clear urine still soaks it, it signifies that the urine is bypassing the bladder and the staining agent. - This scenario strongly suggests a **ureterovaginal fistula**, where urine directly flows from the ureter into the vagina without passing through the bladder. *VVF* - A **vesicovaginal fistula (VVF)** would result in the escape of **dye-filled bladder urine** into the vagina, staining the pad. - The absence of dye on the pad rules out a direct leak from the bladder into the vagina. *Urethrovaginal fistula* - A **urethrovaginal fistula** would also involve urine passing through the bladder and urethra, leading to the **dye staining the vaginal pad**. - The dye would be present in the urine leaking into the vagina, which directly contradicts the clinical presentation. *Urinary stress incontinence* - **Stress incontinence** involves involuntary leakage of urine from the bladder due to increased intra-abdominal pressure, and this urine would also be **dye-stained**. - This diagnosis does not explain why the urine is clear while the bladder is filled with dye.

Question 3: 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 4: Which urinary bladder spasmolytic has local anesthetic properties?

A. Tamsulosin
B. Terazosin
C. Oxybutynin (Correct Answer)
D. Yohimbine

Explanation: ***Oxybutynin*** - Possesses both **anticholinergic properties** (bladder smooth muscle relaxation) and **direct local anesthetic properties**, which contribute to its spasmolytic effect on the detrusor muscle. - The **local anesthetic action** directly reduces bladder detrusor muscle contractions, explaining its efficacy in treating urge incontinence and overactive bladder. - This dual mechanism makes it unique among bladder spasmolytics. *Tamsulosin* - Is an **alpha-1 adrenergic receptor blocker** used for benign prostatic hyperplasia (BPH) by relaxing smooth muscle in the prostate and bladder neck. - Does **not have local anesthetic properties** and is not a bladder detrusor spasmolytic. *Terazosin* - Also an **alpha-1 adrenergic receptor blocker**, similar to tamsulosin, used for BPH and hypertension. - Acts via **vascular and prostatic smooth muscle relaxation**, without local anesthetic or bladder spasmolytic effects. *Yohimbine* - Is an **alpha-2 adrenergic receptor antagonist** known for increasing sympathetic outflow. - Does **not have bladder spasmolytic effects** or local anesthetic properties.

Question 5: Which of the following statements is MOST accurate regarding stress incontinence?

A. There is no complaint of urge to pass urine.
B. Associated with alteration of the urethro-vesical angle.
C. Coincides with periods of raised intra-abdominal pressure. (Correct Answer)
D. Occurs primarily during sleep or at rest.

Explanation: ***Coincides with periods of raised intra-abdominal pressure.*** - **Stress incontinence** is defined by involuntary urine leakage during activities that increase intra-abdominal pressure, such as coughing, sneezing, laughing, or exercising. - This increased pressure overwhelms the weakened urethral sphincter or pelvic floor support. - This is the most accurate defining characteristic of stress incontinence. *There is no complaint of urge to pass urine.* - While **pure stress incontinence** does not involve an urge to void, this statement is too absolute. - **Mixed incontinence** (combination of stress and urge) is common, where patients may have both stress leakage and urgency symptoms. - Therefore, stating definitively "there is no complaint of urge" is not universally accurate. *Associated with alteration of the urethro-vesical angle.* - An **altered urethro-vesical angle** (specifically, loss of the posterior urethro-vesical angle) is a common anatomical finding in stress incontinence. - This represents the underlying anatomical defect contributing to poor bladder neck support. - However, this describes the anatomical consequence rather than the primary clinical presentation. *Occurs primarily during sleep or at rest.* - This is **incorrect** for stress incontinence. - Stress incontinence requires physical exertion or activities that increase intra-abdominal pressure. - Leakage during sleep or at rest would suggest other types of incontinence (overflow, urge, or continuous leakage from fistula).

Question 6: 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 7: 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 8: 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.

Question 9: 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 10: Urinary incontinence in uterovaginal prolapse is mostly due to:

A. Detrusor instability
B. Urge incontinence
C. True incontinence
D. Stress incontinence (Correct Answer)

Explanation: ***Stress incontinence*** - This is the most common type of urinary incontinence in uterovaginal prolapse, especially with **cystocele**, due to weakened pelvic floor muscles and altered urethrovesical angle. - The prolapsed organs reduce support for the urethra and bladder neck, leading to leakage with increased **intra-abdominal pressure** (e.g., coughing, sneezing, lifting). *Detrusor instability* - This refers to involuntary contractions of the **detrusor muscle**, causing a sudden, strong desire to urinate (urgency), often leading to leakage. - While it can coexist, it is not the primary cause of incontinence directly attributable to the mechanical effects of uterovaginal prolapse. *Urge incontinence* - Characterized by an urgent need to urinate followed by involuntary leakage, often due to **detrusor overactivity**. - Although it can occur in individuals with prolapse, it is a functional bladder issue rather than a direct mechanical consequence of the anatomical descent associated with prolapse. *True incontinence* - This is a broad term that can encompass continuous leakage or total loss of bladder control, often associated with neurological damage, fistula, or severe anatomical defects. - While prolapse can contribute to some forms of incontinence, "true incontinence" does not specifically define the predominant mechanism seen in most cases of uterovaginal prolapse.

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