Tjahjodjati Subdivision Urology Surgery Department, Medical Faculty Padjadjaran University / Hasan Sadikin Hospital
Dec 23, 2015
Tjahjodjati
Subdivision Urology Surgery Department, Medical Faculty
Padjadjaran University / Hasan Sadikin Hospital
DEFINITIONDEFINITION
URINARY INCONTINENCE IS DEFINED AS THE INVOLUNTARY LEAKAGE OF URINE,PERCEIVED BY THE SUFFERER , AS A SOCIAL OR HYGIENE PROBLEM.
1. Urge Urinary Incontinence
The involuntary leakage of urine accompanied by or immediately proceeded by urgency
2. Stress Urinary Incontinence
The complaint of involuntary leakage of urine on effort or exertion, or sneezing or coughing
3. Overflow Urinary Incontinence
The complaint of involuntary leakage of urine due to overdistention of bladder. It is usually caused by infravesical obstruction or flaccid bladder.
4. Reflex Urinary Incontinence The complaint of leakage of urine due to detrusor involuntary
5. Continous Urinary Incontinence : The complaint of continous urine leakage. It is caused
usually by urinary fistula ,ex: vesicovaginal fistula,ureterovaginal fistula, extopic ureter, extrophia bladder.
6. Nocturnal Enuresis : The complaint of involuntary loss of urine that occurs
during sleep
7. Mixed Urinary Incontinence : is mixed of urge and stress urinary incontinence
NEURAL CONTROL OF MICTURITION
MICTURITION AND URINE STORAGE
Bladder Filling & Bladder Filling & Emptying CycleEmptying Cycle
1. Bladder fills
2. First desire tourinate (bladderhalf full)
3. Urinationvoluntarily inhibiteduntil time and placeare right
The cycle ofbladder fillingand emptying
Urination
Detrusor musclecontracts
Urethralsphincterrelaxes
Urethralsphinctercontracts
Detrusor muscle relaxes
History
How long symptoms exist, any correlation with strainning (coughing or laughing), voiding sensation
History of Surgery : Urology or Gynecology Patient Mobility : Handicap to go to the toilet Mental Status : Dementia, Psychologycal Problem Medication/Drugs : Sedative Hypnosis, Diuretic,
Antidepresant Concomitant Disease : Asthma Brochiale, COPD Obstretrical History : Pregnancy, Delivery, High
Birth Weight
Impact of Incontinence to the person’s Quality of Life :
Severity of Symptoms : Voiding Diary chart
Physical Examination General Status Supra pubic : full bladder or not ,pain External genital : Perineum : skin rash,
eritema, uterine prolaps, cystocele, rectocele, strictur, stone
Neurologic : sensation, reflex bulbocavernosus
Rectal : prostat, feces consistency, sphincter tone
Laboratory Examination
Urinalysis : UTI, Hematuria Post void Residual Urine Uroflowmetri PAD Test Urodynamic Imaging : BNO-IVP, USG
STRESS INCONTINENCESTRESS INCONTINENCE
Directed to the Etiology : Stress U.I
Pelvis Floor Excercises Weighted Vaginal Cone Electro Stimulation Surgery : - TVT
- Kolposuspension
Urge U.I Bladder Retraining Medication : anti muscarinic agent Surgery
Overflow U.I : Relief the obstruction (surgery)
Continous U.I: Treat the Etiology/ close the fistula/defect (surgery)
THANK YOU FOR YOUR THANK YOU FOR YOUR ATTENTIONATTENTION