URINARY

INCONTINENCE

Urology Division,
Surgery Department
Medical Faculty,
University of Sumatera
Utara
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References
References

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Definition
 The complaint of any involuntary leakage of urine
 That is social or hygienic problem

ICS 2009
EPIDEMIOLOGY
 Twice as common in women as in men.
 Prevalence estimates :
female : 5% - 69%
male : 1 % - 39 %
 Incidence of Urinary Incontinence increased with
age.
Estimated number of individuals with UI 2008, 2013 and 2018
 Estimated Worldwide Number of Individuals with
Incontinence by Region (In Millions)
Estimated Number of Individuals with
Incontinence

Region 2008 2013 2018

World 346 383 420

Africa 33 38 43

North America 32 34 47

South america 20 22 24

Asia 206 231 256

Europe 54 56 57
 Predisposing Factors
1. AGE
2. PREGNANCY, PARITY AND
PARTURITION
FEMALE 3. OBESITY AND BODY MASS
4. HORMONES (MENOPAUSE )
5. HYSTERECTOMY
6. DIABETES
7. GENETICS
1. AGE
2. LUTS AND INFECTIONS
3. FUNCTIONAL AND COGNITIVE
MALE IMPAIRMENT
4. NEUROLOGICAL DISORDERS
(mengingo-myelocele and spinal injuries,
Parkinson’s disease and multiple sclerosis.)
5. PROSTATECTOMY
CLASSIFICATION
1. Stress Urinary Incontinence (SUI)
2. Urgency Urinary Incontinence (UUI)
3. Mixed Urinary Incontinence (MUI)
4. Post-micturition dribble and Continuous Urinary
Incontinence
5. Nocturnal Enuresis
Co Morbid conditions
D elirium
I nfection
A trophic vaginitis
P harmaceutical
P sychological disorder
E ndocrine disorder
R estricted mobility
S tool impaction
1. STRESS URINARY INCONTINENCE (SUI)

 The complaint of involuntary leakage on effort or

exertion, or on sneezing or coughing
 Leakage with increase in intra abdominal pressure
 Urethral sphincter malfunction (intrinsic weakness),
bladder neck hypermobility
 Associated with weakning pelvic floor muscle
 Loss small or to moderate amount of urine
 No evidence of urgency or nocturia
2. URGENCY URINARY INCONTINENCE (UUI)

 The complaint of involuntary leakage accompanied by

or immediately preceded by urgency
 Detrusor overactivity
 Frequency
 Night time voiding
 Most common in older women
3. MIXED URINARY INCONTINENCE (MUI)

 The complaint of involuntary leakage associated with

urgency and also with exertion, effort, sneezing or
coughing.

4. CONTINUOUS URINARY INCONTINENCE

● The complaint of continuous leakage ectopic ureteral insertion

vagino vesical fistula post radical prostatectomy
 5. Nocturnal Enuresis
 Any involuntary loss of urine occurring during sleep.
Initial Assessment of Urinary
Incontinence
 History
 Physical Examination
 Laboratory
 Basic office testing
GENERAL MEDICAL HISTORY

1. Urinary symptoms
 Description of precipitating and aggravating factors of
urinary loss.
 Time of onset
 Duration of symptoms
 Micturition pattern
 Voiding difficulties
 Degree of difficulties
GENERAL MEDICAL HISTORY

2. Obstetric/Gynaecology History
- Number of pregnancies
- Children’s birth weights
- Type of deliveries
- Menstrual status
3. Medications
4. Medical History
GENERAL MEDICAL HISTORY

5. Surgical History
6. Bowel Habits
7. Sexual History (Dyspareunia, vaginal dryness
and coital incontinence)
8. Prolapse symptoms: The feeling of a lump
(“something coming down”)
Physical Examination
a. General examination:
1. bladder, bowel, or sexual, function , height
and weight and body mass index
2. Neurological examination sacral
pathways
3. Rectal examination
b. Abdominal examination
Scars from previous surgery
Palpate the kidneys and bladder
c. Vaginal examination
.
d. Perineal/genital inspection
 Presence of any abnormal anatomical
 Atrophy or excoriation, and erythema due to
incontinence
 Wearing of pads.

e) Urethro-vesical junction (bladder neck) mobility

 Visual inspection (lithotomy position)
 Q-tip test (Urethrovesical junction hypermobility is
defined by a axis exceeding +30 degrees from the
horizontal
 Laboratory and Basic office test
Urinalisis and uine cytology
Post-void residual urine
Uroflowmetry
Urodynamic
Pad weighing test to assess degree of incontinence
Collect mid-stream urine for culture and microscopy
Cough stress test
Creatinine
PSA ( male )
 Imaging
Upper Tract
 Ultrasnography ( USG )
 Intravenous Urography ( IVU )
 Computerize Tomography ( CT )
 Magnetic Resonance Imaging ( MRI )
Lower Tract
Voiding cystourethrogram (VCUG)
ICS 2009 / EAU Guideline 2010
ICS 2009 / EAU Guideline 2010
MANAGEMENT
 CONSERVATIVE TREATMENTT
1. Genuine Stress Incontinence
Conservative therapy is indicated :
- The patient refuses or is undecided about surgery
- The patient is mentally or physically unfit
- Childbearing continues
- There is uncontrolled detrusor instability or voiding
difficulty.
 Lifestyle interventions : reduce body weight, stop
caffein
 Pharmacoherapy
 Pelvic floor muscle training
 Vaginal cones
 Electrical stimulation
Drugs used in the treatment of stress urinary
incontinence
Drug LE GR

.Duloxetine 1 B
• Imipramine 3 NR
• Clenbuterol 3 C
• Methoxamine 2 NR
• Midodrine 2 C
• Ephedrine 3 NR
• Norephedrine 3 NR
(phenylpropanola
mine) 2
• Oestrogen NR

NR: Not Recomen

2. Urgency urinary incontinence (uui)
Conservative therapy :
- Bladder Training
- Pharmocotherapy :
* Antimuscarinic Drugs
* Antidiurectics
* Oestrogen Replacement
● SURGICAL TREATMENT
A. Genuine Stress Incontinence
- Bulking Agents
urethra and bladder neck injection :
* Teflon
* Collagen
* Silica
- Needle Suspension
- Colposuspension
* The Burch Colposuspension
* Marshall-Marchetti-Krantz Procedure
- Sling Operation
* Tension-free vaginal tape procedure (TVT)
* Stamey bladder neck suspension
- Artificial Urinary Sphincter (AUS)
B. Continuous Urinary Incontinence
 * ureterovaginal fistel
 * vesico-vaginal fistel Repair Fistel
 * urethrovaginal fistel
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