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UTI and Stress Incontinence

By AdminPosted On 05-Oct-2016

1. Most common type of incontinence seen in UTI


a) Stress incontinence

b) Overflow incontinence

c) Urge incontinence

d) Mixed incontinence

e) Structural incontinence


Correct Answer: c) Urge incontinence is when urine leaks before reaching the toilet when one has urgency. Urge incontinence is the common form of incontinence with UTI as it causes irritation of the bladder.


2. UTI during Pregnancy


29-year, G2P1, at 38 wks gestation has frequent painful contractions. Her prenatal course was significant for a urine culture that showed 100,000 colony-forming units/ml of Group-B streptococci. Examination shows that she is contracting every 2 min and her cervix is 5 cm dilated and 80% effaced. Which of the following medications should this patient be treated with during labor and delivery?


a) Betamethasone

b) Folic acid

c) Magnesium sulfate

d) Oxytocin

e) Penicillin

Correct Answer: e) Penicillin. Two primary methods are used to determine which women will receive antibiotics during labor. The first method is based upon risk factors. The five risk factors are: 1. History of a GBS-affected neonate. 2. Urine culture with GBS. 3. Preterm labor (37 weeks). 4. Membranes ruptured for greater than eighteen hours in labor. 5. Temperature greater than 38.0 C (100.4 F) in labor. A woman with any one of these five risk factors should receive antibiotics in labor. The second method is based on screening, with pregnant women being screened for GBS at 35 to 37 weeks with a culture of the vagina, perineum, and anus. She should be treated with penicillin during labor and delivery.


3. UTI in Postmenopausal Woman

67-year-old woman has frequency and dysuria. She has hypertension for which she takes a beta-blocker, but no other medical problems. She states that she is not sexually active. She does not smoke and drinks cranberry juice daily. Examination shows mild suprapubic tenderness and genital atrophy but is otherwise unremarkable. Urinalysis shows 50-100 leukocytes/hpf and 8 RBC/hpf. Which of the following is the most likely cause of the infection?


a) Cardiac disease

b) Cranberry juice ingestion

c) Hypoestrogenism

d) Nephrolithiasis

e) Sexual intercourse


Correct Answer: c) Hypoestrogenism. Presentation is most consistent with UTI. Two of the major risk factors for uncomplicated UTI are sexual intercourse and hypoestrogenism. Hypoestrogenism is believed to be a risk factor for UTI. Estrogen administration has been shown to prevent recurrent infection. Cranberry juice ingestion has, for many years, been believed to help prevent UTIs.


4. Stress Incontinence

Which medication may be used to reduce the symptom of stress incontinence?


a) Desmopressin

b) Duloxetine

c) Fluoxetine

d) Imipramine

e) Tolterodine

Correct Answer: b) Duloxetine. Duloxetine is a balanced serotonin and noradrenaline reuptake inhibitor. It increases urinary sphincter tone and has been shown to reduce incontinence by about 50%, with improvements in quality of life. Tolterodine and oxybutynin are muscarinic receptor antagonists and are used in urge incontinence.


5. The muscle strengthen by routine Kegel exercise is

a) Obturator internus

b) Piriformis

c) Iliococcygeus

d) Pubococcygeus

e) Bulbocavernosus


Correct Answer: d) Pubococcygeus. It is now known that the components of levator ani (the pelvic diaphragm), namely pubococcygeus, puborectalis and ileococcygeus, contract and relax as one muscle. Hence, pelvic floor exercises involve the entire levator ani rather than pubococcygeus alone.


6. Bladder Nerve Supply


Sympathetic supply to the bladder is derived from which lumbar segments?


a) L1 and L2

b) L2 and L3

c) L3 and L4

d) L4 and L5

e) S2 , S3 and S4

Correct Answer: a) L1 and L2. Nerve root supply for pelvic organs is a common single best answer examination question. It is worth drawing a table for each of the main pelvic organs and writing down the artery, venous, lymphatic and nerve supply. Note that the parasympathetic supply for the bladder comes from S2, S3 and S4 but the sympathetic is as above. Sensory nerves are found in both supplies.


7. Bladder and Micturation


a) The normal residual volume of bladder is 0-100mL

b) The bladder capacity is 350 mL

c) The maximum urethral pressure in the absence of micturation is 50-100 cm H2O

d) The maximum urine flow rate is 5 mL/s

e) Detrusor sensation is relayed through the sympathetic nervous system.


Correct Answer: c. 1) Maximum urethral pressure varies with age and childbearing. 2) The normal residual volume of bladder is 0-10mL. 3) The bladder capacity is 600 mL 4) The maximum urine flow rate is 20-40 mL/s. 5) Detrusor sensation is relayed through the pelvic splanchnic nerves to the sacral roots of S2-S4 (Parasympathetic).


8. Identify this instrument used in gynaecology.



Correct Answer: TOT needle (Outside in). In the evolution of surgical procedures for SUI, latest techniques are TOT, TVT-O (Inside out) and Miniarc. All these techniques has one surgical principle of “Midurethral sling”.

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Dr. Niraj Mahajan

MD- Gynecologist, Laparoscopic Surgeon, Uro-gynecologist , Infertility specialist & Cosmetic Gynecologist.

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