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Incontinência urinária

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seminário 06/07/12

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Incontinência urinária

  1. 1. Mariana Olival da Cunha marianaolival@ig.com.brIncontinência urinária: o estudourodinâmico é indispensável? Mariana Olival da Cunha (R2) Orientadora: Dra. Rebecca Sotelo
  2. 2. Definições* • IU: perda involuntária de urina, representando um problema social ou higiênico • IUE: perda involuntária de urina sincrônica ao esforço, espirro ou tosse • IUU: perda involuntária de urina associada ou imediatamente precedida por urgência miccionalInt Urogynecol J (2010) 21:5–26Valor da Queixa Clínica e Exame Físico no Diagnóstico da Incontinência Urinária - RBGO - v. 24, nº 2, 2002Diagnóstico clínico e subsidiário da incontinência urinária - Rev Bras Ginecol Obstet. 2006; 28(1): 54-62
  3. 3. Definições • IUM: IUE + IUU • Bexiga hiperativa: urgência, com ou sem urgeincontinência, acompanhada de aumento da freqüência miccional e noctúria • Incontinência postural: perda involuntária de urina com a mudança de posição • Perda insensível* • Incontinência coital: penetração e orgasmoInt Urogynecol J (2010) 21:5–26Diagnóstico clínico e subsidiário da incontinência urinária - Rev Bras Ginecol Obstet. 2006; 28(1): 54-62
  4. 4. Epidemiologia • 18% das mulheres com mais de 30 anos de idade* • Alta prevalência (12,7 - 37%) • 35% mulheres climatéricas • 50% mulheres de casa de repouso • 29 – 75% IUE • 7 – 33% hiperatividade do detrusorQualidade de vida em mulheres com incontinência urinária - Rev Bras Ginecol Obstet. 2006; 28(6): 352-7Estudo urodinâmico da pressão de perda ao esforço, nas posições ortostática e sentada, em mulherescom incontinência urinária - Rev Bras Ginecol Obstet. 2007; 29(2):91-5ACOG Practice Bulletin No. 63 Urinary Incontinence in Women - VOL. 105, NO. 6, JUNE 2005
  5. 5. Anamnese • Início dos sintomas • Duração • Gravidade (diário miccional*) • Condições associadas* • Impacto social e higiênico • Medicações em uso • ComorbidadesDiagnóstico clínico e subsidiário da incontinência urinária - Rev Bras Ginecol Obstet. 2006; 28(1): 54-62ACOG Practice Bulletin No. 63 Urinary Incontinence in Women - VOL. 105, NO. 6, JUNE 2005
  6. 6. King’s Health Questionnaire QuestionárioRev Bras Ginecol Obstet. 2005; 27(5): 235-42
  7. 7. Exame Físico • Reproduzir e caracterizar a incontinência • Excluir distúrbios neurológicos • Avaliar o suporte pélvico* • Análise da mucosa vaginal* • Sinais de dermatite amoniacal • Distopias genitais • Mobilidade uretral (Q-tip test)Diagnóstico clínico e subsidiário da incontinência urinária - Rev Bras Ginecol Obstet. 2006; 28(1): 54-62ACOG Practice Bulletin No. 63 Urinary Incontinence in Women - VOL. 105, NO. 6, JUNE 2005
  8. 8. Fatores de risco • Etnia branca • Alto IMC • Parto vaginal • Parto traumático (fórceps e episiotomia) • Multiparidade • Gestação em idade avançadaSintomas urinários e qualidade de vida em mulheres - FISIOTERAPIA E PESQUISA 2007; 1 4(3): 1 2-7
  9. 9. Fatores de risco • Diabetes • Menopausa • Constipação • Cirurgias pélvicas radicais • Ocupações que exijam esforço físico (atletas)Sintomas urinários e qualidade de vida em mulheres - FISIOTERAPIA E PESQUISA 2007; 1 4(3): 1 2-7
  10. 10. Estudo urodinâmico • Objetivo: identificar as causas específicas dos sintomas das pacientes (incontinência urinária, disfunção miccional, sintomas irritativos do trato urinário) e fornecer dados para orientar o correto tratamento. • EAS e URCDiagnóstico clínico e subsidiário da incontinência urinária - Rev Bras Ginecol Obstet. 2006; 28(1): 54-62
  11. 11. Estudo urodinâmico • Fluxometria* + Resíduo pós-miccional • Cistometria* • Estudo miccional*Int Urogynecol J (2010) 21:5–26ACOG Practice Bulletin No. 63 Urinary Incontinence in Women - VOL. 105, NO. 6, JUNE 2005
  12. 12. Estudo urodinâmico • PPE < 60 cmH2o: Defeito esfincteriano intrínseco • PPE > 90 cmH2o: IUEDiagnóstico clínico e subsidiário da incontinência urinária - Rev Bras Ginecol Obstet. 2006; 28(1): 54-62Urodynamic evaluation of women with incontinence - ©2012 UpToDate ®
  13. 13. Estudo urodinâmico: Sim ou Não • Queixa IUE isolada + exame físico 25% erro diagnóstico • Defeito esfincteriano e hipermobilidade do colo vesical • Tratamento cirúrgico X conservador • Defesa médicaDiagnóstico clínico e subsidiário da incontinência urinária - Rev Bras Ginecol Obstet. 2006; 28(1): 54-62
  14. 14. Estudo urodinâmico: Sim ou Não• 27% de chance de modificar o tratamento• Resultados não fisiológicos*• Falta padronização• Normalidade não exclui anormalidade clínica• Sintomatologia não condizente com exame físico• Falha do tratamento conservadorUrodynamic evaluation of women with incontinence - ©2012 UpToDate ®
  15. 15. USG • Estimar o resíduo miccional • Detectar tumores vesicais e distorções na parede vesical • Avaliação da vascularização dos tecidos periuretrais por meio do efeito doppler e da musculatura do assoalho pélvico • Avaliar a hipermobilidade e a posição do colo vesicalDiagnóstico clínico e subsidiário da incontinência urinária - Rev Bras Ginecol Obstet. 2006; 28(1): 54-62
  16. 16. Tratamento • IUE: cirúrgico, fisioterapia – exercícios de Kegel • IUU: anticolinérgicos ou anti-muscarínicos, reeducação vesical, exercícios de Kegel, toxina botulínicaIncontinência Urinária Feminina - Acta Urológica 2007, 24; 1: 79-82
  17. 17. Bibliografia• Urodynamic evaluation of women with incontinence - ©2012 UpToDate ®• Int Urogynecol J (2012) 23:813–822 DOI 10.1007/s00192-012- 1693-3• Int Urogynecol J (2010) 21:5–26• 2009 Wiley-Liss, Inc.• Impacto do estudo urodinâmico em mulheres com incontinência urinária - Rev Assoc Med Bras 2007; 53(2): 1225
  18. 18. Bibliografia• Incontinência Urinária Feminina - Acta Urológica 2007, 24; 1: 79-82• Diagnóstico clínico e subsidiário da incontinência urinária - Rev Bras Ginecol Obstet. 2006; 28(1): 54-62• ACOG Practice Bulletin No. 63 Urinary Incontinence in Women - VOL. 105, NO. 6, JUNE 2005• Rev Bras Ginecol Obstet. 2005; 27(5): 235-42• Valor da Queixa Clínica e Exame Físico no Diagnóstico da Incontinência Urinária - RBGO - v. 24, nº 2, 2002• Int Urogynecol J (2000) 11:188–195 - 2000 Springer-Verlag London Limited

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