Williams Gynecology, Second Edition (Schorge,Williams Gynecology), 2nd Edition

CHAPTER 23
Urinary Incontinence

23–1. Involuntary loss of urine with coughing or sneezing typically reflects which of the following forms of incontinence?

a. Urge incontinence

b. Stress incontinence

c. Overflow incontinence

d. Functional incontinence

23–2. Involuntary loss of urine preceded by a strong sensation to void reflects which of the following forms of incontinence?

a. Urge incontinence

b. Stress incontinence

c. Overflow incontinence

d. Functional incontinence

23–3. If the symptoms of overactive bladder or urge incontinence are objectively demonstrated by urodynamic testing, which of the following terms is used?

a. Detrusor overactivity

b. Functional incontinence

c. Genuine urge incontinence

d. Verified urge incontinence

23–4. If stress incontinence is documented by urodynamic testing, which of the following terms is used?

a. Detrusor overactivity

b. Functional incontinence

c. Verified urge incontinence

d. Urodynamic stress incontinence

23–5. Of the forms of incontinence, which is the most common in the general ambulatory female population?

a. Urge

b. Stress

c. Overflow

d. Functional

23–6. A risk factor for urinary incontinence includes which of the following?

a. Nonsmoking

b. Nulliparity

c. Advanced age

d. Sickle cell anemia

23–7. Hypoestrogenism is linked to a greater risk of incontinence through which of the following mechanisms?

a. Increased urethral collagen volume

b. Atrophy of the urethral mucosal seal

c. Increased compliance of urethral sphincter musculature

d. All of the above

23–8. Childbirth likely contributes to urinary incontinence through which of the following mechanisms?

a. Nerve damage from stretch injury

b. Prolonged pudendal nerve latency

c. Direct injury to connective tissue attachments

d. All of the above

23–9. The layer indicated by the beige-highlighted label in the image below is responsible for what function(s)?

Image

Reproduced, with permission, from McKinley M, O’Loughlin VD: Urinary system. In Human Anatomy. New York, McGraw-Hill, 2006, Figure 27-9.

a. Aids greater permeability at the urine–plasma barrier

b. Prohibits bacterial adherence and prevents urothelial damage

c. Allows for rapid multidimensional expansion during bladder filling

d. All of the above

23–10. Which statement correctly describes innervations of the bladder?

a. The autonomic division of the peripheral nervous system innervates striated muscle.

b. The sympathetic system acts via acetylcholine binding to α-or β-adrenergic receptors.

c. The somatic component of the peripheral nervous system innervates smooth muscle.

d. Autonomic fibers supplying the pelvic viscera course in the inferior and superior hypogastric plexi.

23–11. How do the structures whose label is highlighted in orange in this image contribute to the bladder’s capacity for urine storage or emptying?

Image

Reproduced, with permission, from Barrett KE, Barman SM, Boitano S, et al (eds): Renal function and micturition. In Ganong’s Review of Medical Physiology, 23rd ed. New York, McGraw-Hill, 2010, Figure 38-20.

a. Voluntary contraction or relaxation of the urogenital sphincter complex

b. Involuntary relaxation of the detrusor muscle for bladder filling

c. Involuntary contraction of the detrusor muscle for bladder emptying

d. None of the above

23–12. Which of the following statements regarding the parasympathetic division of the autonomic nervous system and its innervation of the bladder is correct?

a. Acetylcholine acts via α-or β-adrenergic receptors.

b. The urethra’s outlet must contract in concert with detrusor contraction to aid voiding.

c. Muscarinic antagonist medications will augment detrusor contraction and worsen urinary incontinence.

d. Of the five subtypes of muscarinic receptors, M2 and M3 are the ones predominantly responsible for detrusor smooth muscle contraction.

23–13. The urethra’s ability to maintain a tight seal and prevent urinary incontinence requires which of the following?

a. Urethral mucosal coaptation

b. Healthy underlying vascular plexus

c. Contraction of muscles surrounding the urethra

d. All of the above

23–14. When the patient’s history suggests an overlap in both stress and urge incontinence symptoms, which of the following terms is used?

a. Overflow incontinence

b. Mixed urinary incontinence

c. Complex urinary incontinence

d. Augmented urinary incontinence

23–15. Diabetes mellitus likely contributes to urinary incontinence through which mechanism?

a. Decreased urine output

b. Worsening peripheral edema

c. Bladder mucosal inflammation

d. Osmotic diuresis and polyuria

23–16. A urethral diverticulum is suggested by which of the following?

a. Postvoid dribbling

b. Suburethral bulging of the anterior vaginal wall

c. Transurethral expression of fluid when compressing the anterior vaginal wall

d. All of the above

23–17. Which of the following CANNOT be assessed or measured using simple cystometrics?

a. Total bladder capacity

b. Stress urinary incontinence

c. Intrinsic sphincteric deficiency

d. First sensation of bladder filling

23–18. The test depicted in the image, which graphically demonstrates a patient’s maximum rate, duration, and pattern of flow during voiding, is known as which of the following?

Image

Reproduced, with permission, from Tanagho EA, Deng DY: Urodynamic studies. In Tanagho EA, McAninch JW (eds): Smith’s General Urology, 17th ed. New York, McGraw-Hill, 2008, Figure 28-1.

a. Uroflowmetry

b. Cystometrography

c. Cystourethrography

d. Urethral pressure profile

23–19. Pressure flowmetry is useful for determining which of the following?

a. Maximum flow rate

b. Incomplete bladder emptying from obstructive causes

c. Incomplete bladder emptying from poor detrusor contractility

d. All of the above

23–20. All EXCEPT which of the following statements are true regarding pelvic floor muscle therapy (PFMT) for treatment of urinary incontinence?

a. Patients are asked to forcefully contract their abdominal muscles just before a cough or sneeze.

b. Over a series of weeks, patients steadily increase the duration of muscle contraction.

c. Rapid contraction and relaxation (i.e., “quick flicks”) of the pelvic floor muscles may be helpful for treatment of urge urinary incontinence.

d. A predictor of likely poor response to PFMT is baseline prolapse beyond the hymenal ring.

23–21. Local estrogen therapy may help in the treatment of mild urinary incontinence via which mechanism?

a. Increased collagen deposition

b. Increased α-adrenergic receptor sensitivity

c. Increased vascularity of the periurethral capillary plexus

d. All of the above

23–22. Which of the following statements regarding the procedure depicted in the image is true?

Image

Reproduced, with permission, from Schaffer JI, Hoffman BL: Surgeries for female pelvic reconstruction. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 42-6.1.

a. This may only be performed for women with intrinsic sphincteric deficiency.

b. It is best performed only in an operating room under adequate regional or general anesthesia.

c. The injection location around and along the length of the urethra varies from patient to patient.

d. The injectable material is designed to dissolve over time as it is frequently immunogenic.

23–23. The antiincontinence procedures described by Burch and Marshall-Marchetti-Krantz are examples of which of the following?

a. Midurethral sling procedures

b. Periurethral bulking techniques

c. Retropubic urethropexy procedures

d. Transvaginal needle suspension procedures

23–24. All EXCEPT which of the following statements are true regarding the two procedures demonstrated in the images below?

Image

Reproduced, with permission, from Schaffer JI, Hoffman BL: Surgeries for female pelvic reconstruction. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figures 42-3.5 and 42-4.4.

a. Long-term urinary incontinence cure rates are 75 to 85 percent.

b. This can usually be performed in a day-surgery /outpatient setting.

c. Bladder injury is more common in the transobturator route compared with the retropubic route.

d. Possible complications include worsening urinary urgency, mesh erosion, urinary retention, and vascular injury.

23–25. What are the most common side effects that patient complain about when using oral oxybutynin or tolterodine?

a. Nausea and vomiting

b. Headaches and tinnitus

c. Dry mouth and constipation

d. Skin irritation and pruritus

23–26. Before botulinum toxin A is used for idiopathic detrusor overactivity, the patient should be informed of which of the following true statements?

a. The effects will likely last for 3 to 4 years.

b. Temporary self-catheterization may be required if urinary retention occurs.

c. Postprocedural urinary retention usually leads to painful distension, urinary tract infections, or pyelonephritis.

d. All of the above

Chapter 23 ANSWER KEY

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