urinary incontinence - final year lecture
TRANSCRIPT
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By;Mr. Adeel ABBAS
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Define Urinary Incontinence?
Involuntary Loss Of Urine That Can Be
Demonstrated Objectively And Is A Social
Or Hygienic Problem.
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Epidemiology15% to 30%.
Male to Female Ratio 1 : 3.
Elderly.
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CausesUrethral Incontinence
Non-Urethral Incontinence.
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Urethral Incontinence;
1. Urethral Abnormalities
2. Bladder Abnormalities.
3. Non-Urinary Abnormalities.
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Urethral Abnormalities;
•Pelvic Fracture.
•Post-Prostectomy.
•Multiparity.
•Difficult Delivery.
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Bladder Abnormalities.
Cystitis.
Bladder Stones.
Bladder Tumors.
Detrusor Muscle Neuropathy.
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Non-Urinary Abnormalities;
Impaired Mobility.
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Non-Urethral Incontinence;
Ureteral Ectopia.
Urinary Fistula.
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Classification Stress Incontinence.
Urge Incontinence.
Mixed Incontinence.
Overflow Incontinence.
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Stress Incontinence Is Urinary Leakage
When Intra-abdominal Pressure Exceeds
Urethral Pressure.
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Urge Incontinence Is Urinary Leakage
Caused By Rise In Intra-vesical Pressure
Secondary To Uninhibited Bladder
Contraction From Detrusor Hyperactivity.
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Mixed Incontinence Is A Combination Of
Stress & Urge Incontinence.
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Overflow Incontinence Is Urinary
Incontinence Caused By Bladder Atonia
Secondary Damage To The Efferent Fibers Of
The Sacral Reflex.
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Clinical Features Stress Incontinence.?
Urge Incontinence.?
Nocturnal Enuresis.?
Features of Infection, Trauma, Fistula…
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Clinical Features Stress Incontinence.?
Urinary Leakage During Coughing, Straining,
Etc Are Quite Specific.
Urge Incontinence.?
Inability To Maintain Urine Continence In The
Presence Of Frequent And Insistent Urges To
Void.
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Nocturnal Enuresis.?
10% of 5 years Old Normal.
5% of 10 years Old Normal.
Bed-Wetting in Older Children
Abnormal.
Indicate Unstable Bladder.
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Investigations?Urine Culture.IVU.Urodynamics;
Uroflowmetry.Cystometry.Postvoid Residual Volume.
Cystoscopy.MRI.Vaginal Speculum Examination.
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Medical Treatment:Loose Weight.Pelvic Floor Exercise.
Surgical Treatment:Urethropexy.Artificial Sphincter.Vaginal Repair.
Management of Stress Incont:
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Management of Urge Incont:Medical Treatment:
Modify Fluid Intake.Avoid Caffeine / Alcohol.Treat Underlying Cause.Anticolinergics (Oxybutynin)
Surgical Treatment:Cystoplasty.
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Avoid Medications That Cause Detrusor Hypoactivity.
If Obstruction…? Treat Cause.
If No Obstruction…?Clean Intermittent Self Catheterization.
Management of Overflow Incont:
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Surgery…
Management of Urinary Fistula
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