Download - 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