URINARY INCONTINENCE

Imam D Azrul, SpU

CAMPBELL-WALSH UROLOGY
EAU GUIDELINE
LECTURES (FKUI/FKUNAIR)
Introduction
Urinary Incontinence (UI)
Social economic impact
Female > Male
Geriatric sociatic
Western : > 65 y.o.
Indonesia : > 60 y.o.

USA (over 1.1 mil visit $ 19.5 bil)

Indonesia ???
Relevant Factors UI
Type
Frequency
Severity
Social impact
Effect on hygiene and QoL
Measure used to contain the leakage
Precipating factor
Indivual seek or desire for help
Effect and Incidence of UI
Effect UI
Quality of life
Medical cost
Incidence UI
The believe
Its nature for geriatric
Nothing can be done

ICEBERG PHENOMENA
Effect and Incidence of UI
USA : 13 -17 % (Stothers et al 2005)
Urepic Study :
Seoul :8%
Birmingham : 23 %

CULTURAL DIFFERENCE ??
Definition
Urinary Incontinence (UI)
UI is the involuntary loss of urine
Sign and Symptoms
LUTD (Lower Urinary Tract Dysfunction)
Leakage on sneezing, coughing...
Observation of frequency volume charts
Pad test
Ect
Urodynamic Evaluation
Underlying couses
Detrusor overactivity, detrusor underactivity, sphicter dysenergy...
Definition
By symptom (4):
Continuous Incontinence
Fistula gynecologic surgery, radiation, obstetric trauma
Ectopic ureter
Stress Incontinence
Urgency Incontinence
Overflow Incontinence
TYPE UI
Stress UI (activity related)
Urge UI (overactive bladder)
Mixed UI (mixed stress-urge UI)
Neurogenic lower urinary tract dysfunction (reflex
incontinence)
Overflow UI (BOO / Urinary retention)
Stress UI
Symptomatic complaint
Involuntary leakage on effort, or exertion, or on sneezing, or
coughing
Sign
Involuntary urinary loss from the urethra synchronous with
exertion, sneezing and coughing
Urodynamic diagnosis
Involuntary leakage of urine during increase in abdominal
pressure in absence of a detrusor contraction urodynamic
stress incontinence
Urgency UI
Symptomatic complaint
Involuntary leakage accompanied by or immediately preceded
urgency or urge
Sign
Involuntary urinary loss from the urethra that accompanied or
immediately precede by urgency
Urodynamic diagnosis
Related to an involuntary detrusor contraction during
urodynamic detrusor overactivity associated
incontinence
Mixed UI
Symptomatic complaint
Involuntary leakage associated with urgency ALSO with effort,
exertion, sneezing, or coughing
Sign
Involuntary urinary loss from the urethra synchronous with effort,
exertion, sneezing, or coughing AND Involuntary urinary loss from
the urethra that accompanied by or immediately precede by urgency
Urodynamic diagnosis
BOTH involuntary leakage of urine during increase in abdominal
pressure. Its related to an involuntary detrusor contraction during
urodynamic detrusor overactivity associated incontinence
PRESENT in 40% female with SUI
CampbellWalsh
Urology 10th ed
Assessment
Chief complaint : urinary leakage
History
Urinary frequency (more > 8x/day or every 1 hour)
Disturbing Nocturia
Pregnancydelivery
Parkinson-Stroke-DM neuropathic
Trauma / Injury spinal cord injury
Malignancy Radiation
BOO
Medication history
ACTH (chronic cough), blocker (SUI), agonist (retention)..
Psychological status
Obesity
Bladder History Voiding diary
2-3 days before consult
Assessment
Physical Exam
Supra pubic area
Palpation of bladder, scarr
Examination through genital area
Leakage with effort or continuously, fistula, organ prolaps, infection,
dermatitis due to urine
Strictures, divericulum of urethra
DRE :
Rectal tone, BCR
BPH
Scibala
Neurologic exam motoric - sensoric
Other Examination
LAB
Renal function unit
Urinalysis with culture
PSA test
Ultrasound to exclude stone, tumor,..
Pad test
Uroflowmetry
Urodynamic ???
Management
Underlying disease
(Organ Prolaps / Post TURP / Stroke / Bladder Stone / Tumor)
Treat correctable condition :
D : Delirium anxiety
I : Irritants coffee, alcohol
A : Atrophic vaginitis
P : Pharmacologic
P : Psychologic : depression UI
E : Excessive urine production
R : Restricted mobility
S : Stool impaction
Management
Behavioral therapy
Education
Physiotherapy
Life style interventions
Pelvic Mucle Therapy...
Pharmacologic therapy
blocker BOO
5-ARI BPH
Antimuscarinic
(Oxibutinin/Toltoradine/Solifenacin/Propiverine) OAB
Management
Surgical Therapy
TVT / TOT SUI
Organ prolaps OBGYN
TURP BPH BOO / overflow
BOTOX, Neuromodulation, accupuncture OAB
Bladder cystoplasty