Download - Lud09 jun-16
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Physiology of Micturition
to store urine effortlessly, painlessly, and without
leakageto discharge urine
voluntarily, effortlessly, completely, and painlessly.
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The bladder
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Normal Urethral Closure
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Micturition
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Urinary Incontinence
two broad types:anatomic hypermobility of the urethraintrinsic sphincteric weakness or deficienc
y (ISD)Both?
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UI: Definition
??? “the complaint of any involuntary leakage of urine”
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Incontinence (symptom) The complaint of any involuntary leakage of urine
Stress urinary incontinence (symptom) The complaint of involuntary leakage on effort or exertion, or on sneezing or coughing
Stress urinary incontinence (sign) Observation of involuntary leakage from the urethra, synchronous with exertion/effort, or sneezing or coughing
Urge urinary incontinence (symptom) The complaint of involuntary leakage accompanied by or immediately preceded by urgency
Mixed incontinence Complaints of both stress and urge incontinence
UI: Definition
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UI: Risk Factors
AgePregnancyChildbirthObesityFunctional impairmentCongnitive impairmentMedical conditions
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UI: initial Evaluation
HistoryPhysical examinationSimple tests
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UI: History
SymptomsGeneral med hxPast surgeryCurrent medicationHow often, how much, what provokes, wh
at improves or worsens, what treatment
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UI: QoL
How their lives affectedTo what degree
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UI: Physical examination
General medical conditionsProblems related to UI
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Neurologic
Mental status
Perineal sensation
Perineal reflexes
Patellar reflexes
Abdominal examination
Masses
Cardiovascular
Congestive heart failure
Lower extremity edema
UI: Physical examination
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Mobility
Gait assessment
Pelvic examination
Prolapse
Atrophy
Levator muscle palpation (symmetry, ability to squeeze)
Anal sphincter function
Test of urethral mobility (e.g., Q-tip test)
UI: Physical examination
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Voiding Diary
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Urinalysis
to exclude infection, hematuria, and metabolic abnormalities
see whether improved with eradication of bacteriuria.
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Postvoid Residual Volume
<50ml -----Normal>200ml --------Abnormal
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Cough Stress Test
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Advanced Testing
UrodynamicsUroflowmetryFilling CystometryImaging testNeuroPhysiologic test
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Treatment: nonsurgical
Lifestyle changesPhysical therapyBehavioral Therapy and Bladder Training Vaginal and Urethral Devices
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Treatment: nonsurgical
Vaginal and Urethral Devices
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Treatment: nonsurgical
Vaginal and Urethral Devices
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Treatment: SurgicalTension-free Vaginal Tape TVTTension-free Vaginal Tape TVT
Burch OptBurch Opt
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Bulking agents
Treatment: Surgical
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Fistula
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Conclusion
Bladder storage and emptying depend on a complex interplay between the brain, spinal cord, bladder, urethra, and pelvic floor.
Urinary incontinence is common in women and is generally treated successfully with a range of nonsurgical and surgical treatments.
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ConclusionSUI occurs with increases in abdominal press
ure (such as coughing, running, lifting) and can be treated with pelvic muscle exercises, vaginal devices, lifestyle changes, and surgery.
Urge urinary incontinence occurs with a sudden sense of urgency (such as on the way to the bathroom or when washing hands) and can be treated with bladder training, medications, lifestyle changes, and neuromodulation
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A requiem to the Burch . Paulo Palma1 Department of Female Urology, Universidade Estadual de Campinas, Cidade Universitária “Zeferino Vaz”, Barão Geraldo, Campinas, Sao Paulo, 13083-970, Brazil