evidence based management and treatment of urinary incontinence stress urinary incontinence

EVIDENCE BASED MANAGEMENT AND

TREATMENT OF URINARY INCONTINENCE STRESS

URINARY INCONTINENCE

DR m. EMAMI

CASE STUDY #1

A 51-year old otherwise healthy woman presents to your clinic with complaints of feeling the urge to void.

She manages not to void before entering the house, Also she has urinary leakage with strong cough or

laughing

Vaginal Exam : Mild cystocele and rectocele with urethral hypermobility

BMI=25 U/A: N ICIQ-UI SF Score:5 PVR:10 cc

TREATMEMTWhat are reasonable expectations

for pharmacological therapy?

What is a reasonable treatment plan?

TOTTVTPFMTColporraphy

TREATMENTFirst-line treatment for stress incontinence

includes pelvic floor exercises with 30 to 50 daily contractions(Level 1 – And grade of recommendation A)

A reduction of 5 to 10% in the baselineweight resulted in an approximately 50%

reductionin the frequency of incontinence.

CASE#2 SEVERE CYSTOCELE

47 years old Mild stress incontinence Pelvis heaviness and gr 4 cystocele

cause angulations of urethrovesical angle in this lady

Patient always uses manual reduction of bladder to void

Large residual urine and low flow rate

CYSTOCELE GRAD 4

V UDS

WHAT IS THE NEXT OPTION?TVTTraditional ReductionMesh surgeryTOT with Colporraphy

CASE#3A 50 years old lady with moderate mixed

incontinence and failer to emptyingHistory of colporraphy a year agoTyp II urgencyDetrusor overactivity after 200 cc volumFlow rate 16 ml/s and detrusor pressure at

peak flow :10 with interrupted patternBiofeedback and PFMT, anticholinergic failed

COUGH V VALSALVA LEAK-POINT PRESSURE

VIDEOURODYNAMIC RESULTS AFTER COLPORRAPHY AND KELLY PROCEDURE

YOUR PLAN TVT TOT BURCH BOTOX injection Or?????????

SLING RESULT

SLING EFFICACY

SLING COMPLICATION

CONCLUSIONS