Definitions Flashcards
urgency
sudden and compelling desire to pass urine that is difficult to defer
Incontinence
‘the complaint of involuntary loss of urine’
stress urinary incontinence (SUI)
the complaint of involuntary leakage on effort or exertion or on sneezing or coughing
urgency urinary incontinence (UUI)
complaint of involuntary leakage accompanied by or immediately preceded by urgency (sudden and compelling desire to pass urine which is difficult to defer)
OAB syndrome
‘urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology ( stones cancer metabolic)
complicated UI - 7
haematuria fistula recurrent infections suspected or proven voiding problems after pelvic irradiation radical pelvic surgery previous incontinence surrgery
nocturnal enuresis
‘the complaint of involuntary loss of urine which occurs during sleep’
types of incontinence
SUI MUI UUI continuous NE insensible coital
Modified Oxford Scale of pelvic floor muscle strength
0No contraction 1Flicker 2Weak 3Moderate 4Good 5Strong
Baden Walker Classification of POP
0 Normal no prolapse 1 Prolapse halfway to introitus 2 prolapse to introitus 3 prolapse partly through introitus 4 prolapse completely past introitus
incontinence questionnaires
ICIQ-UI
ICIQ-FLUTS
ICIQ-MLUTS
preop UDS in SUI
Preoperative UDS in women with uncomplicated clinically demonstrable SUI does not improve outcome of surgery for SUI
No evidence that preoperative DO is associated with surgical failure of MUS in women
Preoperative DO may be associated with persistence of urgency post operatively
NICE indications for UDS 4
Urge predominant MUI or UI in which type unclear
Symptoms suggestive voiding dysfunction
Anterior or apical prolapse
History of previous surgery for SUI
24 hour and 1 hour pad test
1 hour pad test using a standardised exercise protocol and a diagnostic threshold of 1.4g shows good specificity but lower sensitivity for SUI and MUI
24 pad test with threshold of 4.4g is more reproducible but difficult to standardise with activity level
1 hour pad test protocol
drink 500mls fluid
within 15 mins series of standardised exercises lasting one hour
increase in pad weight 1 g or more diagnostic of UI
nice recommendation pad tests
Do not use pad tests in the routine assessment of women with urinary incontinence
conservative measures
PDE lose weight fluid management bowel function drugs pads and containment timed prompted voiding in elderly and care dependent people
treatment options urge predominant
anti muscarinics
mirabegron
PTNS
treatment SUI
MUS - synthetic or autologous
Pubovaginal sling
colposuspension
urethral bulking
men with PPI EAU recommendation
fixed sling or AUS
NICE stress predominant MUI
If stress incontinence is the predominant symptom in mixed urinary incontinence, discuss with the woman the benefit of non-surgical management and medicines for overactive bladder before offering surgery
weight loss
Three SRs plus two large RCTs concluded that weight loss was beneficial in improving UI
no evidence conservative measures
smoking caffeine fluid intake exercise catheter washes spc vs urethral antibiotic prophylaxis with catehter catheter material conveen vs catheter constipation other drugs
NICE conservative measures
caffeine reduction in women with OAD
high or low fluid intake to modify if UI with OAB
BMI more than 30 to lose weight if UI or OAB
reassess yearly women using pads
Offer a trial of supervised pelvic floor muscle training of at least 3 months’ duration as first-line treatment to women with stress or mixed urinary incontinence
Offer bladder training lasting for a minimum of 6 weeks as first-line treatment to women with urgency or mixed urinary incontinence
If women do not achieve satisfactory benefit from bladder training programmes, the combination of an overactive bladder medicine with bladder training should be considered if frequency is a troublesome symptom
