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Urology Division,

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 %

Incidence of Urinary Incontinence


increased
with age

Estimated number of individuals with


UI 2008, 2013 and 2018

Individuals with Incontinence by


Region (In Millions)
Estimated Number of Individuals with
Incontinence
Region

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

1. Stress Urinary Incontinence

(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)

The complaint of involuntary leakage on

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

2. URGENCY URINARY INCONTINENCE


(UUI)
The complaint of involuntary leakage
accompanied by or immediately
preceded
by urgency
Detrusor overactivity
Frequency
Night time voiding
Most common in older women

3. MIXED URINARY INCONTINENCE (MUI)


The complaint of involuntary
leakage associated with urgency
and also with exertion, effort,
sneezing or coughing
4. CONTINUOUS URINARY INCONTINENCE
The complaint of continuous leakage
ectopic ureteral insertion
vagino vesical fistula
post radical prostatectomy

5.

Nocturnal Enuresis
Any involuntary
loss of urine
occurring during
sleep

Initial Assessment of
Urinary
Incontinence
History
Physical
Examination
Laboratory
Basic office testing

GENERAL MEDICAL HISTORY


1. Urinary symptoms
Description of precipitating and
aggravating
factors of urinary loss.
Time of onset
Duration of symptoms
Micturition pattern
Voiding difficulties
Degree of bother

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

(Dyspareunia,vaginal dryness and


coital incontinence)

8. Prolapse symptoms

The feeling of a lump (something


coming down)

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.

e) Urethro-vesical junction (bladder


neck)
mobility
Visual inspection (lithotomy position)
Q-tip test (Urethrovesical junction

Laboratory and Basic office


test
Urinalisis and urine cytology
Post-void residual urine
Uroflowmetry
Urodynamic
Pad weighing test to assess degree of
incontinence
Collect mid-stream urine for culture and
microscopy
Cough stress test
Creatinine
PSA ( male )

Imaging
Upper Tract

Ultrasonography ( USG )
Intravenous Urography ( IVU )
Computerize Tomography ( CT )
Magnetic Resonance Imaging
( MRI )

Lower Tract
Voiding cystourethrogram
(VCUG)

ICS 2009 / EAU Guideline 2010

ICS 2009 / EAU Guideline 2010

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

Drugs used in the treatment of stress


urinary incontinence
Drug

.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

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