lud09 jun-16

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Urinary Incontinence(UI)

Shunjia HONG洪顺家hongshunjia@yahoo.com

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Physiology of Micturition

to store urine effortlessly, painlessly, and without

leakageto discharge urine

voluntarily, effortlessly, completely, and painlessly.

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The bladder

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Normal Urethral Closure

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Micturition

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Urinary Incontinence

two broad types:anatomic hypermobility of the urethraintrinsic sphincteric weakness or deficienc

y (ISD)Both?

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UI: Definition

??? “the complaint of any involuntary leakage of urine”

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Incontinence (symptom)    The complaint of any involuntary leakage of urine

Stress urinary incontinence (symptom)    The complaint of involuntary leakage on effort or exertion, or on sneezing or coughing

Stress urinary incontinence (sign)    Observation of involuntary leakage from the urethra, synchronous with exertion/effort, or sneezing or coughing

Urge urinary incontinence (symptom)    The complaint of involuntary leakage accompanied by or immediately preceded by urgency

Mixed incontinence    Complaints of both stress and urge incontinence

UI: Definition

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UI: Risk Factors

AgePregnancyChildbirthObesityFunctional impairmentCongnitive impairmentMedical conditions

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UI: initial Evaluation

HistoryPhysical examinationSimple tests

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UI: History

SymptomsGeneral med hxPast surgeryCurrent medicationHow often, how much, what provokes, wh

at improves or worsens, what treatment

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UI: QoL

How their lives affectedTo what degree

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UI: Physical examination

General medical conditionsProblems related to UI

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Neurologic

    Mental status

    Perineal sensation

    Perineal reflexes

    Patellar reflexes

Abdominal examination

    Masses

Cardiovascular

    Congestive heart failure

    Lower extremity edema

UI: Physical examination

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Mobility

    Gait assessment

Pelvic examination

    Prolapse

    Atrophy

    Levator muscle palpation (symmetry, ability to squeeze)

    Anal sphincter function

    Test of urethral mobility (e.g., Q-tip test)

UI: Physical examination

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Voiding Diary

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Urinalysis

to exclude infection, hematuria, and metabolic abnormalities

see whether improved with eradication of bacteriuria.

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Postvoid Residual Volume

<50ml -----Normal>200ml --------Abnormal

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Cough Stress Test

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Advanced Testing

UrodynamicsUroflowmetryFilling CystometryImaging testNeuroPhysiologic test

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Treatment: nonsurgical

Lifestyle changesPhysical therapyBehavioral Therapy and Bladder Training Vaginal and Urethral Devices

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Treatment: nonsurgical

Vaginal and Urethral Devices

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Treatment: nonsurgical

Vaginal and Urethral Devices

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Treatment: SurgicalTension-free Vaginal Tape TVTTension-free Vaginal Tape TVT

Burch OptBurch Opt

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Bulking agents

Treatment: Surgical

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Fistula

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Conclusion

Bladder storage and emptying depend on a complex interplay between the brain, spinal cord, bladder, urethra, and pelvic floor.

Urinary incontinence is common in women and is generally treated successfully with a range of nonsurgical and surgical treatments.

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ConclusionSUI occurs with increases in abdominal press

ure (such as coughing, running, lifting) and can be treated with pelvic muscle exercises, vaginal devices, lifestyle changes, and surgery.

Urge urinary incontinence occurs with a sudden sense of urgency (such as on the way to the bathroom or when washing hands) and can be treated with bladder training, medications, lifestyle changes, and neuromodulation

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谢谢！hongshunjia@yahoo.com

13798066370

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A requiem to the Burch . Paulo Palma1 Department of Female Urology, Universidade Estadual de Campinas, Cidade Universitária “Zeferino Vaz”, Barão Geraldo, Campinas, Sao Paulo, 13083-970, Brazil