Urinary Incontinence

Επηρεάζει η Ακρατεια ούρων την ποιότητα ζωής;

Η ακράτεια των ούρων, οποιασδήποτε μορφής κι αν είναι, επιδρά σαρωτικά στη ζωή των ασθενών, εκλαμβανομένη ως μια βαθιά απώλεια της υγείας, που προκαλεί θυμό και λύπη, καθώς και αίσθημα ντροπής και κατάθλιψης. Οι ασθενείς αποφεύγουν τις κοινωνικές εκδηλώσεις και εμφανίζουν σημαντική απώλεια της αυτοπεποίθησής τους, με αντίκτυπο στις κοινωνικές συναναστροφές, στη σεξουαλική ζωή και στην ψυχική τους υγεία.

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Urinary incontinence is defined by the International Continence Society (www.icsoffice.org ) as the involuntary loss of urine that represents a hygienic or social problem to the individual.

Urinary incontinence can be thought of as a symptom as reported by the patient, as a sign that is demonstrable on examination, and as a disorder.

Urinary incontinence should not be thought of as a disease, because no specific etiology exists.

An estimated 50-70% of women with urinary incontinence fail to seek medical evaluation and treatment because of social stigma. Only 5% of individuals who are incontinent and 2% of nursing home residents who are incontinent receive appropriate medical evaluation and treatment. Patients who are incontinent often cope with this condition for 6-9 years before seeking medical therapy(http://evdomadaakrateias.blogspot.com/ )

Four types of urinary incontinence are defined in the Clinical Practice: stress, urge, mixed, and overflow. Some authors include functional incontinence as a fifth type of incontinence.

Stress incontinence is characterized by urine leakage associated with increased abdominal pressure from laughing, sneezing, coughing, climbing stairs, or other physical stressors on the abdominal cavity and, thus, the bladder.

Urge urinary incontinence is involuntary leakage accompanied by or immediately preceded by urgency.

Mixed urinary incontinence is a combination of stress and urge incontinence; it is marked by involuntary leakage associated with urgency and also with exertion, effort, sneezing or coughing.

Functional incontinence is the inability to hold urine due to reasons other than neuro-urologic and lower urinary tract dysfunction.

Evaluation

Patients with urinary incontinence should undergo a basic evaluation that includes a history, physical examination, and urinalysis. Additional information from a patient’s voiding diary, cotton-swab test, cough stress test, measurement of postvoid residual (PVR) urine volume, cystoscopy, and urodynamic studies.

Multichannel urodynamic testing in patients with these factors confirmed the diagnosis of stress incontinence 97% of the time.

Urodynamics are a means of evaluating the pressure-flow relationship between the bladder and the urethra for the purpose of defining the functional status of the lower urinary tract. The ultimate goal of urodynamics is to aid in the correct diagnosis of urinary incontinence based on pathophysiology.

Simple urodynamic tests involve performing a noninvasive uroflow study, obtaining a postvoid residual (PVR) urine measurement, and performing single-channel cystometrography (CMG). A single-channel CMG is used to assess the first sensation of filling, fullness, and urge. Bladder compliance and the presence of uninhibited detrusor contractions can be noted during this filling CMG.

Multichannel urodynamic studies can be used to obtain additional information, including a noninvasive uroflow, PVR urine, filling CMG, abdominal leak-point pressure (ALPP), voiding CMG (pressure-flow), and electromyography (EMG).

Urodynamic testing is expensive and requires specialized equipment and expertise. The availability of testing facilities is not universal.

The potential importance of urodynamic testing lies in the fact that the outcome of therapy is tied to understanding the pathophysiology in any given case and to making the correct and complete diagnosis.Urodynamics are the best tests available for examination of lower urinary tract function.

Treatment 

Treatment is keyed to the type of incontinence. The usual approaches are as follows:

• Stress incontinence – Surgery, pelvic floor physiotherapy, anti-incontinence devices, and medication

For women with stress urinary incontinence, tension-free vaginal tape provides lasting relief, according to results of a 10-year follow-up study.( Visit my publications) TVT is the least invasive procedure, with the least number of potential complications for the patient.

The tension-free midurethral slings are the most effective and popular way to manage SUI surgically and are currently considered the gold standard.

Post-Procedure

Immediate Postoperative Care

After surgery, administer intravenous (IV) antibiotics for 24 hours, followed by an oral antibiotic for several days. On the following morning, remove vaginal packing and IV lines. Also, remove the dressing over the incision. Discharge patients from the hospital with pain medications the day after surgery.

• Urge incontinence – Changes in diet, behavioral modification, pelvic-floor exercises, and/or medications and new forms of surgical intervention

The goal of therapy is to improve the symptoms of frequency, nocturia, urgency, and urge incontinence. Treatment options include anticholinergics and antispasmodic agents.

Pharmacologic therapy for stress incontinence and an overactive bladder may be most effective when combined with a pelvic exercise regimen. Bioffedback, Pelvic Floor Muscle Exercises

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