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Urinary Stress Incontinence

Urinary stress incontinence is the involuntary passage of small amounts of urine due to transient episodes of raised intraabdominal pressure. This can occur when patients cough, sneeze or lift heavy objects. There are numerous predisposing factors.


Presentation

Urinary stress incontinence (USI) is the passage of urine done without conscious control especially in the case of increased abdominal pressure. Typically, the urine passed is minimal. The cause behind this condition is poorly understood, although there are a number of factors that put individuals at a greater risk of developing USI. Women are more affected by this condition than men, and some of the risk factors specific to the former include pregnancy, vaginal delivery, and menopause [1] [2] [3]. Risk factors that apply to both men and women include obesity, chronically raised intraabdominal pressure as found in chronic obstructive pulmonary disease (COPD), urethral injury, pelvic surgery and smoking [4] [5] [6].

USI occurs when there is an abrupt increase in intraabdominal pressure, usually when coughing, laughing, sneezing, lifting heavy objects, or during physical exertion such as sports. Irritative voiding symptoms such as frequency and urgency, are not part of the clinical picture, and if present, may be indicative of an overactive bladder. The additional presence of hematuria may be a sign of bladder cancer.

USI may arise from a defect in the urethral sphincter, or from the urethra itself. If the urethral sphincter is responsible, symptoms are typically more pronounced, exemplified by urine passage during the action of standing up, or continuous dribbling. The features may be similar to those of a fistula, which if suspected, may be investigated.

Italian
  • Incontinence Urinaire d'Effort ), Incontinence urinaire d'effort, Incontinence d'urine à l'effort German Stress-Urininkontinenz, Streßinkontinenz, Stressinkontinenz, Streßharninkontinenz, Inkontinenz, Streß-, Harninkontinenz, Streß-, Stressharninkontinenz Italian[fpnotebook.com]
  • Apparently the terms “incontinence of effort”, “effort incontinence” and “orthostatic incontinence” had been used to describe the condition in French, Italian, Spanish and Polish publications from the late 50s until the late 70s when the term stress incontinence[ics.org]
  • In an Italian study of 181 consecutive cases of TVT-O surgery, Serati et al found no significant difference between older women (70 years or older) and younger women in terms of cure rate, voiding dysfunction, vaginal erosion, persistent groin pain, or[emedicine.medscape.com]
Urinary Incontinence
  • MATERIALS AND METHODS: One hundred patients with stress urinary incontinence underwent the TVT procedure as part of an observational study.[ncbi.nlm.nih.gov]
Vaginal Bleeding
  • A small amount of vaginal bleeding for 7-10 days following surgery is not unusual. Burch (Colposuspension) For many years this was considered the main operation for the management of SUI.[my.clevelandclinic.org]
  • Continue with annual check-ups and follow-up care, notifying your health care provider if complications develop, such as persistent vaginal bleeding or discharge, pelvic or groin pain, or pain during sexual intercourse.[fda.gov]
  • You may pass small stitches or have light vaginal bleeding/discharge. You will be given pain relief medication after the surgery to take when required.[hey.nhs.uk]

Workup

Physical examination, of the genitals, pelvis, and rectum, and a urinary stress test are routinely done in the investigation of USI. A history of stress symptoms alone is not adequate for diagnosis, nor is it an indication for surgery [7].

There are many studies available for the investigation of urinary incontinence. A combination of a history of stress incontinence, a postvoid residual volume of less than 50 milliliters, a positive cough test and bladder capacity of more than 400 milliliters, has been suggested in the literature, for greater efficiency in the diagnosis of USI. This may be followed by more extensive urinary studies.

Initial investigations involve voiding diaries, pad test, urinalysis, and ultrasound. Further modalities include urodynamic and contrasted radiological studies of the urogenital tract.

Urodynamic studies need not be carried out on every patient, however, they are important if surgical intervention is planned [8]. This is because the former is able to objectively demonstrate the presence of urinary stress incompetence. It is also recommended that the above studies be carried out in patients with prior failed therapy, and if neuropathy is suspected.

Among the urodynamic studies that can be done are post-void urine volume, filling cystometry, and uroflow. More extensive exams include video-urodynamic studies. These tests are important in planning treatment, predicting its outcome and delineating possible reasons for treatment failure.

Treatment

  • After 3 months of HCl duloxetine treatment the mean ALPP was 59.1 cm H(2)O, the mean MUCP was 67.3 cm H(2)O and the mean RLPP was 45.1 cm H(2)O. There was a statistically significant correlation among RLPP, MUCP and ALPP before treatment.[ncbi.nlm.nih.gov]

Prognosis

  • The prognosis of this tumor is excellent and no malignant degeneration has been reported. The most common presentations are obstructive voiding symptoms, irritative symptoms, and hematuria.[ncbi.nlm.nih.gov]
  • Outlook (Prognosis) Getting better takes time, so try to be patient. Symptoms most often get better with nonsurgical treatments. However, they will not cure stress incontinence. Surgery can cure some people of stress incontinence.[pennmedicine.org]
  • What Is the Prognosis of Urinary Incontinence? Urinary incontinence is a treatable condition with an excellent prognosis. Medical and surgical treatments for urinary incontinence can have very high cure rates.[emedicinehealth.com]
  • The third goal of the diagnostic evaluation is to aid in prognosis and selection of treatment. There are few facts and many opinions about predicting the outcome of surgery based on the conditions described above.[auanet.org]

Etiology

  • The etiology of the incontinence may be iatrogenic, environmental, situational, or disease related.[emedicine.medscape.com]
  • ETIOLOGY There are several factors believed to cause or promote SUI or lead to decompensation resulting in SUI ( Table 1 ).[glowm.com]
  • The etiology of the initial surgical failure (intrinsic sphincter dysfunction [ISD], recurrent hypermobility, obstruction, instability) should be understood before undertaking a repair.[ncbi.nlm.nih.gov]
  • ., sneezing, coughing, laughing) Most common in younger women Second most common type in older women Mixed Mixed etiology Combination of urge and stress symptoms Overall most common type Less common Overflow Anatomic obstruction Impaired detrusor contractility[aafp.org]

Epidemiology

  • No difference in epidemiologic and preoperative urinary functional status (SUI stage, and pollakiuria, nocturia, and urgency rates) was found between the groups.[ncbi.nlm.nih.gov]
  • Month Cumulative Success Rate Computed From Kaplan Meier Time-to-event Analysis (Reported as Percent Success). [ Time Frame: Two years ] Success defined as composite measure including: no self-reported incontinence symptoms reported on the Medical, Epidemiologic[clinicaltrials.gov]
  • Epidemiology of Male Urinary Incontinence In older male patients (over 60 years), the prevalence of urinary incontinence is 19% (compared to 37% in older women). Only a minority, however, suffers from pure stress incontinence.[urology-textbook.com]
Sex distribution
Age distribution

Pathophysiology

  • This article focuses on the pathophysiology of genuine or urodynamic stress incontinence (USI) and its surgical management. Until now more than 200 surgical techniques have been described for the treatment of USI.[ncbi.nlm.nih.gov]
  • Pathophysiology and management. London: Butterworths, 1985; pp. 112–128 Google Scholar 23. Shafik A. The posterior approach in the treatment of pudendal canal syndrome. Coloproctology 1992; 14:310–315 Google Scholar 24. Warwick R, Williams PL.[link.springer.com]
  • Urge incontinence pathophysiology Urge incontinence is involuntary urine loss associated with a feeling of urgency.[emedicine.medscape.com]
  • Pathophysiology [ edit ] It is the loss of small amounts of urine associated with coughing, laughing, sneezing, exercising or other movements that increase intra-abdominal pressure and thus increase pressure on the bladder.[en.wikipedia.org]

Prevention

  • Fast twitch muscle fibers are very important to prevent sudden stress situations and prevent loss of control.[medfaxxinc.com]
  • "Surgery   TVT-O" group reported a higher rate of major complications (p CONCLUSIONS: Postoperative SUI prevention at the time of prolapse repair remains a challenging issue.[ncbi.nlm.nih.gov]
  • By doing so, the weight of the abdominal contents pressing against the pelvic floor is lessened and prevents the pelvic floor from weakening further. Eat a diet rich in fibre and drink between 1.5 - 2 oz of fluids per day.[kkh.com.sg]
  • Prevention Doing Kegel exercises may help prevent symptoms. Women may want to do Kegels during and after pregnancy to help prevent incontinence. References American Urological Association website.[pennmedicine.org]
  • Can stress urinary incontinence be prevented? Doing kegel exercises may help prevent symptoms. Women who are pregnant may want to do kegels during and after pregnancy to help prevent incontinence.[my.clevelandclinic.org]

References

Article

  1. Kuh D, Cardozo L, Hardy R. Urinary incontinence in middle aged women: childhood enuresis and other lifetime risk factors in a British prospective cohort. J Epidemiol Community Health. 1999;53(8):453–458.
  2. Groutz A, Gordon D, Keidar R, et al. Stress urinary incontinence: prevalence among nulliparous compared with primiparous and grand multiparous premenopausal women. Neurourol Urodyn. 1999;18(5):419–425.
  3. Foldspang A, Mommsen S, Djurhuus JC. Prevalent urinary incontinence as a correlate of pregnancy, vaginal childbirth, and obstetric techniques. Am J Public Health. 1999;89(2):209–212.
  4. Brown JS, Seeley DG, Fong J, Black DM, Ensrud KE, Grady D. Urinary incontinence in older women: Who is at risk? Study of osteoporotic fractures research group. Obstet Gynecol. 1996;87(5 Pt 1):715–721.
  5. Magon N, Kalra B, Malik S, Chauhan M. Stress urinary incontinence: What, when, why, and then what? J Midlife Health. 2011;2(2):57-64.
  6. Bump RC, McClish DK. Cigarette smoking and urinary incontinence in women. Am J Obstet Gynecol. 1992;167(5):1213–1218.
  7. Summitt RL Jr, Stovall TG, Bent AE, Ostergard DR. Urinary incontinence: correlation of history and brief office evaluation with multichannel urodynamic testing. Am J Obstet Gynecol. 1992;166(6 Pt 1):1835-40;discussion 1840-1844.
  8. Rovner ES, Wein AJ. Treatment Options for Stress Urinary Incontinence. Rev Urol. 2004;6(Suppl 3):S29-S47.

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Last updated: 2019-06-28 09:56