MCQ Surgery Answer 8

The Correct Answer is D/ ?C

Stress incontinence, the second most common cause of established incontinence in older women (it is rare in men), is characterized by symptoms and evidence of instantaneous leakage of urine in response to stress. Leakage is worse or occurs only during the day unless another abnormality (e.g., detrusor overactivity) is also present. On examination, with the bladder full and the perineum relaxed, instantaneous leakage upon coughing strongly suggests stress incontinence, especially if it reproduces symptoms and if urinary retention has been excluded by a post voiding residual determination; a several-second delay suggests that leakage is instead caused by an involuntary bladder contraction induced by coughing.

Surgery is the most effective treatment with a cure rate of 75 to 85 percent. For women who can comply indefinitely, pelvic muscle exercises are an option for mild to moderate stress incontinence; if not contraindicated, an alpha-adrenergic agonist (e.g., phenylpropanolamine) is also helpful in such cases, especially if combined with oestrogen. Occasionally, a pessary or even a tampon (for women with vaginal stenosis) provides some relief.

Mild stress incontinence can be treated nonoperatively with medications, hormonal supplementation, or biofeedback techniques. Modalities such as urethral plugs and anterior vaginal wall prostheses are under investigation. Moderate to severe stress incontinence responds to surgical procedures aimed at supporting the anterior vaginal wall (vaginal, laparoscopic, or abdominal operations) or enhancing urethral closure when stress incontinence is secondary to internal sphincter deficiency (periurethral injection of teflon or collagen or insertion of an artificial urinary sphincter).

Category: Surgery MCQs