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Urinary Incontinence

Urinary Incontinence

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Urinary Incontinence

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  1. Urinary Incontinence Tjahjodjati Subdivision Urology Surgery Department, Medical Faculty Padjadjaran University / Hasan Sadikin Hospital

  2. DEFINITION URINARY INCONTINENCE IS DEFINED AS THE INVOLUNTARY LEAKAGE OF URINE,PERCEIVED BY THE SUFFERER , AS A SOCIAL OR HYGIENE PROBLEM.

  3. Classification • Urge Urinary Incontinence The involuntary leakage of urine accompanied by or immediately proceeded by urgency

  4. Classification 2. Stress Urinary Incontinence The complaint of involuntary leakage of urine on effort or exertion, or sneezing or coughing

  5. Classification 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.

  6. Classification 4. Reflex Urinary Incontinence The complaint of leakage of urine due to detrusor involuntary

  7. Classification 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

  8. NEURAL CONTROL OF MICTURITION

  9. MICTURITION AND URINE STORAGE

  10. Bladder Filling & Emptying Cycle 1. Bladder fills Detrusor muscle relaxes 2. First desire to urinate (bladder half full) Urethral sphincter contracts The cycle of bladder filling and emptying Urethral sphincter relaxes Detrusor muscle contracts 3. Urination voluntarily inhibited until time and place are right Urination

  11. How To Diagnose 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

  12. How To Diagnose • Impact of Incontinence to the person’s Quality of Life : Severity of Symptoms : Voiding Diary chart

  13. VOIDING DIARY

  14. How To Diagnose 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

  15. How To Diagnose Laboratory Examination • Urinalysis : UTI, Hematuria • Post void Residual Urine • Uroflowmetri • PAD Test • Urodynamic • Imaging : BNO-IVP, USG

  16. STRESS INCONTINENCE

  17. TREATMENT Directed to the Etiology : • Stress U.I • Pelvis Floor Excercises • Weighted Vaginal Cone • Electro Stimulation • Surgery : - TVT - Kolposuspension

  18. 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)

  19. THANK YOU FOR YOUR ATTENTION