Urinary

Incontinence

Dr.dr. Kadek Budi Santosa Sp.U(K)

Urology Staff Sanglah Hospital
Female and functional urology
consultant
Increased abdominal Involountary contraction Blockage of the
pressure under stress of the bladder muscle urethra
(weak pelvic floor
muscle)
 Has no organic causes

Cognitive or physical factors à impair the

person’s ability to reach or use toilet effectively

Functional – Impaired mobility / – Poor eyesight

Incontinence dexterity – Poor environment /
– Dementia / cognitive change in environment
impairment – Hospitalisation
– Confusion – Institutionalism
WHAT CAUSES INCONTINENCE ??
ANAMNESA
IN STRESS URINARY INCONTINENCE
 ANAMNESA
IN URGE URINARY INCONTINENCE

Urgency urinary incontinence associated with detrusor overactivity (

MANAGEMENT OF STRESS URINARY INCONTINENCE
MANAGEMENT OF STRESS URINARY INCONTINENCE

CONSERVATIVE TREATMENT
BEHAVIORAL THERAPY
PELVIC FLOOR THERAPY

SURGICAL THERAPY
URETHRAL BULKING
SLING PROCEDURE
BURCH COLPOSUSPENSION
CONSERVATIVE TREATMENT
Sling Procedure
BURCH Colposuspension
Colposuspension (BURCH)
 Burch
Colposuspension
1. Effective surgical procedures for
SUI
Laparoscopic approach >>
minimally invasive
2. Midurethral sling – the new gold standard for SUI

Burch remain important procedure for recurrent

incontinence and as the primary treatment (patients
desire a surgical option that does not involve graft
Carey et al. BJOG 2006
placement) ! Jelovsek et al. BJOG 2008
MANAGEMENT OF URGE INCONTINENCE

Leakage urine with detrusor overactivity (DO)

Management
• Lifestyle intervention
• Urinary containment
• Catheterization
(neurogenic OAB)
• Behavioral and
physical therapies
• Anti muscarinics • Botulinum toxin
• Beta – 3 agonist • Sacral nerve
stimulation
• Bladder
augmentation
• Urinary diversion

Conservative Pharmacological Surgical

+ Failed: Consider
urodynamics
Adapted from EAU Guidelines on Non-Neurogenic Female LUTS 2022
Thank you