Neurourology – Urinary Incontinence

1. Initial clinical assessment of patients with effort incontinence following prostatectomy must include

A. a urodynamic study

B. a urination log

C. urethrocystoscopy

D. cystoscopy


2. What is correct regarding duloxetine?

Α. It is an inhibitor of serotonin/noradrenalin reuptake

B. It was approved for male effort incontinence three years ago

C. EAU guidelines include recommendations for treating male effort incontinence with duloxetine

D. I's most frequent side effect is constipation


3. Which of the following sling systems DO NOT cause obstruction:

Α. Remeex system

B. Invance sling

C. AdVance sling

D. Argus system


4. The method of choice for treating serious effort incontinence is:

A. injection of bulking substances

B. placement of an adjustable sling

C. placement of an artificial sphincter

D. placement of the Pro‐Act‐System


5. What is correct when treating effort incontinence after prostatectomy?

A. long term results of injected bulking substances are very good

B. the Invance system is the treatment of choice for serious incontinence

C. surgical treatment is the first line method in treating incontinence after prostatectomy in the first 6-12 months

D. the combination of pelvic floor exercises with duloxetine has been shown to be more effective than pelvic floor exercises alone


6. Mixed incontinence affects quality of life:

Α. Less than urgency incontinence

Β. More than urgency incontinence

C. As much as urgency incontinence


7. The percentage of mixed incontinence in relation to overall incontinence in women is:

Α. 42%

Β. 11%

C. 29%


8. When there is mixed incontinence and the bladder neck is open, the best surgical treatment is:

Α. Placement of a sling at the level of the urinary bladder neck

Β. Burch colposuspension

C. Non-stress midurethral sling placement


9. In mixed incontinence, the guidelines of the International Continence Society are:

Α. Specialized examination and treatment

Β. Treating the most distressing symptom first

C. Minimally invasive methods as first line treatment

D. Β+C


10. The evidence basis for surgical treatment of mixed incontinence concerns:

Α. Activation of urethral sensory fibers by leaking urine

Β. Activation of detrusor contraction through stimulatory vesicourethral reflex

C. Both of the above

D. None of the above is correct


11. Which of the following sentences is correct concerning anticholinergics?

Α. All anticholinergics are equally well tolerated by patients

Β. Dariphenacin and oxybutynin present the most unfavorable tolerance profile

C. Oxybutynin has the highest rate of patients withdrawing from clinical trials

D. All of the above


12. Anticholinergics in therapeutic doses:

Α. Act mainly on the detrusor muscle but cause urinary retention in only a small percentage of cases

Β. Act in the urinary storage phase

C. Increase bladder capacity and limit urination urgency, frequent urination and urinary incontinence

D. Β+C are correct


13. Which of the following sentences is correct?

Α. Type 4 muscarinic receptors play key-role in normal detrusor contractions

Β. Blood-brain barrier permeability changes in neurological conditions and with age

C. Oxybutynin can affect cognitive functions, sleep and EEG results

D. All of the above


14.  Antimuscarinic receptor level selectivity:

Α. Is higher for oxybutynin

Β. Is higher for dariphenacin

C. Is greater for tolterodine

D. None of the above


15. For preventing incontinence after radical prostatectomy pelvic floor muscle retraining must commence

Α. 2 weeks after catheter removal

Β. Pre-operatively and directly after surgery

C. 1 month after surgery

D. 3 months after surgery


16. What would you consult patients to do so as to decrease incontinence episodes after radical prostatectomy:

Α. Practice bulbar urethral massage after urinating

Β. Treating their constipation

C. Decreasing their alcohol intake

D. All of the above


17. Physical therapy to treat incontinence after radical prostatectomy includes

Α. pelvic floor muscle exercises

Β. bladder retraining

C. biofeedback

D. all of the above


18. In incontinence after radical prostatectomy the pelvic floor muscle rehabilitation plan should last:

Α. 3 weeks

Β. 8 weeks

C. 12 weeks

D. More than 18 weeks


19. Changing prescriptions from listed to generic anticholinergics may:

Α. increase incontinence episodes

Β. increase mouth dryness

C. increase urination frequency

D. All of the above


20. Invasive urodynamic examinations are recommended for:

Α. Patients with urinary incontinence regardless of dysuric complaints

Β. Male patients with symptoms of non-complicated bladder outlet obstruction

C. Patients with mixed urinary incontinence after scheduled surgical restoration

D. All of the above


21. Urodynamic examinations in post-prostatectomy incontinence is indicated when suspecting:

Α. Sphincter deficiency

Β. Detrusor overactivity

C. Presence of symptoms indicating mixed incontinence

D. All of the above are correct



22. In neurogenic dysfunctions of the lower urinary tract:

Α. Detrusor overactivity with a normally functioning outer sphincter is the most usual urodynamic finding in multiple sclerosis

Β. Detrusor underactivity with a normally functioning outer sphincter is the most usual udodynamic finding in multiple sclerosis

C. Detrusor underactivity with dyssynergia of the outer or inner sphincter is the most usual finding in multiple sclerosis

D. Urodynamic examinations is indicated to assess the condition of the lower urinary tract before applying any new form of treatment


23. In the surgical treatment of urinary incontinence:

Α. The morphology of the cervix is not important for the type of surgical treatment

Β. The presence of an overactive detrusor and is not a contraindication for surgical repair of effort incontinence

C. Measuring ureteric pressures is irrelevant in choosing a surgical procedure

D. The presence of a cystocele affects the type of surgical procedure to be chosen


24. Mixed urinary incontinence, when compared to effort incontinence, is believed to affect quality of life:

Α. more

Β. less

C. equally

D. there are no relevant data


25. When correlated to age, effort incontinence rates

Α. increase

Β. remain the same

C. decrease

D. there are no relevant data



26. Which of the following is correct concerning urinary incontinence?

Α. Weight loss in seriously overweight women can improve urge incontinence to the same extent as in effort incontinence

Β. Bladder retraining can help in cases of mixed incontinence

C. A decrease in caffeine intake, combined with bladder retraining, is more effective than bladder retraining alone

D. All of the above


27. Which of the following is correct concerning urinary incontinence?

Α. Physical therapy is recommended as first line treatment in all types of incontinence

Β. Physical therapy is recommended as first line treatment only in effort incontinence

C. Physical therapy, in combination with biofeedback, is recommended as first line treatment in all types of incontinence

D. Both magnetic and exterior surface electrostimulation surpass virtual incontinence treatment


28. Which of the following is correct concerning urinary incontinence?

Α. Estrogen therapy can help restore continence

Β. Anticholinergic treatment is effective in mixed incontinence

C. Mixed urinary incontinence is a positive prognostic factor in the surgical treatment of incontinence

D. All of the above


29. The term ‘mixed incontinence’ means:

Α.  Incontinence due to effort and urgency

Β. Incontinence due to effort and urgency incontinence

C. Incontinence due to bladder overactivity and sphincter deficiency


30. Pad tests

Α. Objectively illustrates incontinence gravity

Β. Illustrates the type of incontinence

C. Neither of the above


31. The Q-tip test

Α. Assesses incontinence gravity

Β. Indicates whether a full urodynamic study is indicated

C. Illustrates the presence of bladder overactivity


32. The degree to which a drug affects the central nervous system depends on

Α. Whether it crosses the blood-brain barrier

Β. Its lipophilicity

C. Α+Β

D. None of the above


33. Mouth dryness is a side effect of anticholinergics, which

Α. is often serious, leading to treatment termination

Β. is common, but usually mild and well-tolerated, if the treatment is effective

C. is rare


34. Anticholinergics:

Α. Are of comparable effectiveness

Β. Have different safety and tolerance profiles

C.  Both Α+Β are correct


35. How long should an urination log ideally last?

Α. 1 day

Β. 3 days

C. 7 days

D. 10 days


36. What is the definition of night-time frequent urination?

Α. Evacuation of > 20% of daily urine volume during the night in young adults

Β.  Evacuation of > 33% of daily urine volume during the night in young adults

C. Evacuation of > 20% of daily urine volume during the night in adults > 65 years

D. Evacuation of > 33% of daily urine volume during the night in adults > 65 years

Ε. A+D

F. Β+C


37. When evaluating nocturia we must:

Α. Take into account all urination after retiring for the night

Β. Also take into account the first urination of the following morning

C. Take into account the number of times one urinates interrupting a night's sleep

D. Take into account the number of times one urinates interrupting a night's sleep, which are followed by and which follow sleeping


38. The most serious undesirable side effect of BOTOX bladder injection is:

Α. Developing antibodies/tolerance

Β. Needing intermittent catheterization post-operatively

C. General muscular weakness

D. Increased frequency of UTIs


39. BOTOX bladder injections:

Α. Are equally effective in patients with multiple sclerosis as well as those with spinal cord injury

Β. Are equally effective at 200 and 300 units

C. Are equally effective when administered repeatedly

D. All of the above are correct


40. The most appropriate antibiotics for the treatment of urinary tract mycoplasma infection are:

Α. Tetracyclines

Β. Quinolones

C. Macrolides

D. Cephalosporins


41. What does the general pelvic floor neurological assessment include?

Α. The bulbar-cavernosus reflex

Β. Involuntary anal sphincter tone

C. Voluntary anal sphincter tone

D. Perineal sensitivity

E. All of the above


42. Which of the following is the correct treatment for overactive/hyper-reflexive bladder?

Α. Pelvic floor physical therapy is a b line treatment following anticholinergic treatment failure

Β.  Sacral root neuro-stimulation is an approved b line treatment

C. Urethra dilation is highly documented

D. Bladder botulinum toxin injections are an approved b line treatment


43. Choose the correct option

Α. Intermittent catheterizations are always performed after urination to ensure evacuation and measure residual urine volume

Β. If the patient succeeds in emptying his/her bladder, they will not need intermittent catheterization

C. The thinnest possible catheter is used so as to avoid injuring the urethra

D. Increased intake of liquids (more than 2.5 litres a day) is necessary to limit UTIs.

Ε. All are incorrect

F. All are correct


44. Patients who are catheterized must:

Α. receive chemo-protection

Β. have a urine culture every month and follow a medication course based on the antibiogram

C. receive an antibiotic course of treatment only when a clinical UTI appears and is symptomatic

D. have a urine culture every three months for monitoring purposes and use this as a therapeutic tool, when a UTI appears


45. Choose what is correct for intermittent catheterization

Α. The cleaning technique entails reusing the same catheter after washing it and inserting it with clean, washed hands

Β. The sterile technique is best, as it limits UTI likelihood

C. The aseptic technique requires cleaning of the genital area with a powerful antiseptic before each catheterization

D. All of the above are correct

Ε. All of the above are incorrect


46. In children with persistent nocturnal enuresis when treated with scheduled awakenings and desmopressin:

Α. Nocturnal polyuria

Β. 44% present detrusor overactivity only during the night

C. Awakening disorders

D. Treatment was not performed as it should have been


47. The pelvic floor muscle which DOES NOT seem to play an important role in urine continence is:

Α. The puboperinealis

Β. The puborectalis

C. The rectourethralis

D. The pubococcyggealis

Ε. Α+D


48. The urethra sphincter:

Α.comprises striated muscle fibers in circular array

Β. Consists of smooth muscle fibers in semi-circular array

C. contains both striated and smooth muscle fibers in two layers

D. Has fast twitch muscle fibers

Ε. Α+C


49. What is NOT true in urinary effort incontinence

Α. The morphology of the cervix is important for the type of surgical treatment to be chosen

Β. Detrusor overactivity is a contraindication for stress incontinence surgery

C. Ureteric pressures measurements are important in choosing the surgical procedure to be performed

D. Colposuspension also repairs/corrects cystocele

Ε. The presence of a cystocele does not affect the type of surgical procedure to be chosen


50. Following cystocele repair using a mesh, de nuovo effort incontinence ratios are:

Α.  5%

Β. 10%

C.   30%

D.   50%

Ε.  60%



Correct answers

1 Β


17 ΔD

25 C

33 Β


49 Β

2 Α

10 C

18 D

26 D

34 C

42 Β

50 Β

3 C

11 C


27 Α

35 Β

43 Ε


4 C

12 D

20 ΓC

28 Β

36 Ε

44 C


5 D

13 D

21  D

29 Β

37 D

45 Α


6 Β

14 Β

22 D

30 Α


46 Β


7 C

15 Β

23 Β

31 C

39 D

47 D


8 Α

16  D

24 Α

32 C

40 C

48 C