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Prolapse, Urogynecology & Infections

Question
10 out of 30
 

A 50-year old woman complains of leakage of urine. After genuine stress urinary incontinence, the most common cause of urinary leakage? (LQ)



A Detrusor dyssynergia
B Unstable bladder

C Ureteral urethra
D Overflow incontinence

Ans. B
Unstable bladder

1. Stress incontinence is the involuntary loss of urine when intravesical pressure exceeds the maximum urethral pressure in the absence of detrusor activity.

2. The most common cause of urinary incontinence is incompetence of the urethral sphincter, termed genuine stress incontinence.

3. The other major cause of incontinence is unstable bladder. An unstable bladder is the occurrence of involuntary, uninhibited detrusor contractions of greater than 15 cm H2O with simultaneous urethral relaxation.

a. Up to approximately 60% of patients presenting with incontinence may have unstable bladder.

b. Other causes of urinary incontinence are less common and include overflow secondary to urinary retention, congenital abnormalities, infections, fistulas, detrusor dyssynergia, and urethral diverticula.

c. Detrusor dyssynergia implies that when the patient has an uninhibited detrusor contraction, there is simultaneous con traction of the urethral or periurethral striated muscle (normally there is urethral relaxation with a detrusor contraction).

4. This is generally seen in patients with neurologic lesions. Urethral diverticula classically present with dribbling incontinence after voiding.

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