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Surgery Department
Medical Faculty,
University of Sumatera
Utara
References
Definition
The complaint of any involuntary leakage
of urine
That is social or hygienic problem
ICS 2009
EPIDEMIOLOGY
Twice as common in women as in men.
Prevalence estimates :
- Female
- Male
: 5% - 69%
: 1 % - 39 %
2008
2013
2018
World
346
383
420
Africa
33
38
43
North America
32
34
47
South america
20
22
24
Asia
206
231
256
Europe
54
56
57
Predisposing Factors
MALE
FEMALE
1. AGE
2. PREGNANCY, PARITY
AND
PARTURITION
3. OBESITY AND BODY
MASS
4. HORMONES
(MENOPAUSE )
5. HYSTERECTOMY
6. DIABETES
7. GENETICS
1. AGE
2. LUTS AND
INFECTIONS
3. FUNCTIONAL AND
COGNITIVE
IMPAIRMENT
4. NEUROLOGICAL
DISORDERS (mengingomyelocele and spinal
injuries, Parkinsons disease
and multiple sclerosis.)
5.
PROSTATECTOMY
CLASSIFICATIO
N
(SUI)
2. Urgency Urinary Incontinence
(UUI)
3. Mixed Urinary Incontinence
(MUI)
4. Post-micturition dribble and
Continuous
Urinary Incontinence
Co Morbid conditions
D elirium
I nfection
A trophic vaginitis
P harmaceutical
P sychological disorder
E ndocrine disorder
R estricted mobility
S tool impaction
1. STRESS URINARY
INCONTINENCE (SUI)
effort or
exertion, or on sneezing or coughing
Leakage with increase in intra abdominal
pressure
Urethral sphincter malfunction (intrinsic
weakness),
bladder neck hypermobility
Associated with weakning pelvic floor muscle
Loss small or to moderate amount of urine
5.
Nocturnal Enuresis
Any involuntary
loss of urine
occurring during
sleep
Initial Assessment of
Urinary
Incontinence
History
Physical
Examination
Laboratory
Basic office testing
2. Obstetric/Gynaecology
History
Number of pregnancies
Childrens birth weights
Type of deliveries
Menstrual status
3. Medications
4. Medical History
5. Surgical History
6. Bowel Habits
7. Sexual History
8. Prolapse symptoms
Physical Examination
a. General examination:
Bladder, bowel, or sexual, function ,height
and
weight and body mass index
Neurological examination sacral
pathways
Rectal examination
b. Abdominal examination
Scars from previous surgery
Palpate the kidneys and bladder
c. Vaginal examination
d. Perineal/genital inspection
Presence of any abnormal anatomical
Atrophy or excoriation, and erythema due
to incontinence
Wearing of pads.
Imaging
Upper Tract
Ultrasonography ( USG )
Intravenous Urography ( IVU )
Computerize Tomography ( CT )
Magnetic Resonance Imaging
( MRI )
Lower Tract
Voiding cystourethrogram
(VCUG)
MANAGEMENT
CONSERVATIVE MANAGEMENT
A. Genuine Stress Incontinence
Conservative therapy is indicated :
The patient refuses or is undecided
about surgery
The patient is mentally or physically
unfit
Childbearing continues
There is uncontrolled detrusor
CONSERVATIVE
THERAPY
Lifestyle interventions : reduce
body
weight, stop caffein
Pharmacoherapy
Pelvic floor muscle training
Vaginal cones
Electrical stimulation
.Duloxetine
Imipramine
Clenbuterol
Methoxamine
Midodrine
Ephedrine
Norephedrine
(phenylpropan
olamine)
Oestrogen
LE
1
3
3
2
2
3
3
GR
B
NR
C
NR
C
NR
NR
2
NR
URGENCY URINARY
INCONTINENCE (UUI)
Conservative therapy :
- Bladder Training
- Pharmocotherapy :
* Antimuscarinic Drugs
* Antidiurectics
* Oestrogen
Replacement
SURGICAL TREATMENT
A. Genuine Stress Incontinence
- Bulking Agents
urethra and bladder neck injection :
* Teflon
* Collagen
* Silica
- Needle Suspension
- Colposuspension
* The Burch Colposuspension
* Marshall-Marchetti-Krantz Procedure
- Sling Operation
* Tension-free vaginal tape procedure
(TVT)
* Stamey bladder neck suspension
- Artificial Urinary Sphincter (AU
Continuous Urinary
Incontinence
* ureterovaginal fistel
* vesico-vaginal fistel
* urethrovaginal fistel
Repair Fistel