![]() An abnormal volume may necessitate multichannel testing. The cotton swab test is positive when there is a 30 degree or greater displacement from the horizontal when the patient is in the supine lithotomy position and straining.Ī post void residual volume of less than 150 ml can help exclude a bladder-emptying abnormality or chronic urinary retention (overflow incontinence). Surgical outcomes are more successful in patients with urethral hypermobility. If there is a delay or if leakage is not demonstrated, multichannel testing is recommended. However, a delay in leakage may be due to cough-induced detrusor over-activity. However, a complicated SU can include a history of UTI, prior pelvic surgery, voiding symptoms, contributing medical conditions, severe pelvic organ prolapse and symptoms associated with urgency or retention.īefore surgery is performed, objective measurement of stress urinary incontinence should be objectively demonstrated with visualization of urinary leakage when the patient is made to cough in the supine position If no leakage occurs, another measurement with the patient standing and coughing with a full bladder of 300 ml of fluid can be attempted. Uncomplicated SUI is defined as leakage on Valsalva or physical exertion with only urethral hypermobility and a postvoid residual (PVR) of less than 150 cc. Any UTI must be treated before proceeding with any further evaluations and therapies.ĭifferentiating uncomplicated from complicated SUI is important. ![]() A urinalysis to identify urinary tract infection (UTI) may be the only necessary laboratory evaluation. Pelvic organ prolapse that extends past the hymen may necessitate multichannel urodynamic testing. Reduction of the prolapse can result in complicated SUI that masks SUI symptoms. ![]() Presence of pelvic organ prolapse suggests need for thorough multi-compartment pelvic evaluation. Performing a physical exam ensures a thorough evaluation of other factors that may contribute to the patient’s symptoms and confound the diagnosis of incontinence such as a urethral diverticulum, fistula, and vaginal discharge. Medication history (diuretics, caffeine, alcohol, anticholinergics, and more may affect bladder function), medical history (assessing the presence of conditions such as diabetes and neurologic disorders), and gynecologic, surgical, and obstetrical histories should be obtained. The diaries record volume, type of fluid intake, frequency and volume of voids, and any nocturnal episodes. Voiding diaries are reproducible diagnostic tools in the setting of SUI. Validated questionnaires exist and should be used to assess for prevalence of SUI symptoms and risk factors, impact on QOL, and response to non-surgical therapies. ![]() Other questions should include precipitating events, frequency, severity, pad use, and effects on the activities of daily living. Questions should elicit symptoms related to bladder storage (frequency, nocturia, urgency, incontinency) and emptying functions (hesitancy, straining, e.g.). Taking a history differentiates the various types of incontinence: stress, urge, chronic urinary retention (overflow), mixed, spontaneous, and nocturnal enuresis. Treatments options for SUI include conservative therapies (pelvic floor exercises, behavioral modifications, continence support devices, and urethral inserts) and surgical treatments options (retropubic urethropexies, autologous, fascial slings, urethral bulking agents, and synthetic midurethral slings. The evaluation begins with history, physical exam, urinalysis, demonstration of stress incontinence, assessment of urethral mobility, and the measurement of a post-void residual (PVR) volume. Of the 16% of adult women with SUI, 78% report bothersome symptoms and 29% of this group have extreme symptoms. ![]() Stress urinary incontinence is an involuntary urinary loss from physical exertion related to increased abdominal pressure, resulting in a reduced quality of life. ![]()
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |