Tjahjodjati Subdivision Urology Surgery Department, Medical Faculty Padjadjaran University / Hasan...

Tjahjodjati

Subdivision Urology Surgery Department, Medical Faculty

Padjadjaran University / Hasan Sadikin Hospital

DEFINITIONDEFINITION

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

1. Urge Urinary Incontinence

The involuntary leakage of urine accompanied by or immediately proceeded by urgency

2. Stress Urinary Incontinence

The complaint of involuntary leakage of urine on effort or exertion, or sneezing or coughing

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.

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

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

NEURAL CONTROL OF MICTURITION

MICTURITION AND URINE STORAGE

Bladder Filling & Bladder Filling & Emptying CycleEmptying Cycle

1. Bladder fills

2. First desire tourinate (bladderhalf full)

3. Urinationvoluntarily inhibiteduntil time and placeare right

The cycle ofbladder fillingand emptying

Urination

Detrusor musclecontracts

Urethralsphincterrelaxes

Urethralsphinctercontracts

Detrusor muscle relaxes

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

Impact of Incontinence to the person’s Quality of Life :

Severity of Symptoms : Voiding Diary chart

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

Laboratory Examination

Urinalysis : UTI, Hematuria Post void Residual Urine Uroflowmetri PAD Test Urodynamic Imaging : BNO-IVP, USG

STRESS INCONTINENCESTRESS INCONTINENCE

Directed to the Etiology : Stress U.I

Pelvis Floor Excercises Weighted Vaginal Cone Electro Stimulation Surgery : - TVT

- Kolposuspension

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)

THANK YOU FOR YOUR THANK YOU FOR YOUR ATTENTIONATTENTION