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Evidence Based Management and Treatment of Urinary incontinence Stress Urinary Incontinence

Evidence Based Management and Treatment of Urinary incontinence Stress Urinary Incontinence. DR m. EMAMI. Case Study #1. A 51-year old otherwise healthy woman presents to your clinic with complaints of feeling the urge to void. She manages not to void before entering the house ,

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Evidence Based Management and Treatment of Urinary incontinence Stress Urinary Incontinence

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  1. Evidence Based Management and Treatment of Urinary incontinence Stress Urinary Incontinence DR m. EMAMI

  2. Case Study #1 • A 51-year old otherwise healthy woman presents to your clinic with complaints of feeling the urge to void. She manages not to void before entering the house, • Also she has urinary leakage with strong cough or laughing • Vaginal Exam : Mild cystocele and rectocele with urethral hypermobility • BMI=25 • U/A: N • ICIQ-UI SF Score:5 • PVR:10 cc

  3. treatmemt What are reasonable expectations for pharmacological therapy? What is a reasonable treatment plan? TOT TVT PFMT Colporraphy

  4. treatment First-line treatment for stress incontinence includes pelvic floor exercises with 30 to 50 daily contractions (Level 1 – And grade of recommendation A) A reduction of 5 to 10% in the baseline weight resulted in an approximately 50% reduction in the frequency of incontinence.

  5. Case#2 Severe Cystocele • 47 years old • Mild stress incontinence • Pelvis heaviness and gr 4 cystocele cause angulations of urethrovesical angle in this lady • Patient always uses manual reduction of bladder to void • Large residual urine and low flow rate

  6. Cystocele grad 4

  7. v uds

  8. What is the next option? TVT Traditional Reduction Mesh surgery TOT with Colporraphy

  9. Case#3 A 50 years old lady with moderate mixed incontinence and failer to emptying History of colporraphy a year ago Typ II urgency Detrusoroveractivity after 200 cc volum Flow rate 16 ml/s and detrusor pressure at peak flow :10 with interrupted pattern Biofeedback and PFMT, anticholinergicfailed

  10. Cough v Valsalva Leak-point pressure

  11. Videourodynamic results after colporraphy and kelly procedure

  12. Your plan • TVT • TOT • BURCH • BOTOX injection • Or?????????

  13. Sling result

  14. Sling efficacy

  15. Sling complication

  16. conclusions

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