Urinary Incontinence

INCONTINENCE OF URINE Dr .Ashraf Fouda Damietta General Hospital

Physiology of Micturition ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],Physiology of Micturition

DEFINITION OF INCONTINENCE OF URINE ,[object Object]

TYPES: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

1. True (continuous) incontinence ,[object Object],[object Object],[object Object],[object Object]

2. False incontinence ( Overflow incontinence) ,[object Object],[object Object],[object Object]

4. Urgency incontinence (precipitancy-detrusor instability or detrusor dyssynergia). ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],Detrusor instability (DI)

[object Object],[object Object],Detrusor instability (DI)

STRESS INCONTINENCE ) SPHINCTER INCONTINENCE-GENUINE STRESS INCONTINENCE)

DEGREES OF STRESS INCONTINENCE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

PHYSIOLOGICAL ANATOMY ,[object Object]

[object Object],PHYSIOLOGICAL ANATOMY

[object Object],The internal urethral sphincter (= bladder sphincter)

The external urethral sphincter ,[object Object]

[object Object],[object Object],[object Object],The external urethral sphincter

[object Object],[object Object]

During micturition the following changes occur: ,[object Object],[object Object],[object Object],[object Object]

Incidence of Subtypes of Urinary Incontinence in Women ,[object Object],[object Object],[object Object]

TYPES OF STRESS INCONTINENCE ,[object Object],[object Object],[object Object]

AETIOLOGY ,[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],AETIOLOGY

[object Object],[object Object],AETIOLOGY In fact vaginal delivery is the commonest cause of stress incontinence.

[object Object],[object Object],[object Object],AETIOLOGY

Pathophysiology of Stress Incontinence ,[object Object],[object Object],[object Object],[object Object]

A) Urethral hypermobility (80 - 90% of patients) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],A) Urethral hypermobility (80 - 90% of patients)

B) Intrinsic Sphincter Dysfunction (10 - 20% of patients) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

A. History ,[object Object],[object Object],[object Object],[object Object]

1. Stress Test ,[object Object],[object Object],[object Object],[object Object],[object Object]

2. Bonney test ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],3. Yousef Test

4. Examination of Urine ,[object Object]

[object Object],[object Object],[object Object],[object Object],5. Cystourethroscopy

[object Object],[object Object],[object Object],[object Object],6. Cystourethrography

7. Urodynamics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],Cystometrogram

Cystometrogram ,[object Object],[object Object],[object Object]

[object Object],Cystometrogram

[object Object],[object Object],Cystometrogram

8. The Cotton-Tip Applicator (Q-Tip) Test ,[object Object],[object Object],[object Object],[object Object]

(Q-Tip) Test ,[object Object],[object Object],[object Object]

[object Object],[object Object],9. Measurement of Urethral Pressure

[object Object],[object Object],[object Object],[object Object]

[object Object],10. Measurement of Urethral Length

[object Object],[object Object],11. Uroflowmetry

[object Object],12. Sonographic

By three-dimension transvaginal ultrasound ,[object Object],[object Object]

[object Object],[object Object],[object Object],By three-dimension transvaginal ultrasound

What laboratory tests are helpful in evaluating incontinence? ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],What laboratory tests are helpful in evaluating incontinence?

Which tests are most helpful in differentiating between GSI and DI? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

I. Prophylactic Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],II. Conservative (non-surgical) Treatment

Conservative treatment cures or improves 50% of cases and include: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],Conservative treatment cures or improves 50% of cases and include:

[object Object],[object Object],[object Object],[object Object],Conservative treatment cures or improves 50% of cases and include:

Il. Surgical Treatment ,[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],1. Kelly operation 1914

2. El-Hemaly urethrorrhaphy operation ,[object Object],[object Object],[object Object]

3. Vaginal tape operation (TVT) 1996 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],3. Vaginal tape operation (TVT)

[object Object],[object Object],[object Object],[object Object],T ension free V aginal T ape (TVT)

[object Object],[object Object],[object Object],[object Object],1. Mashall-Marchetti-Krantz 1949

2. Burch Operation 1968 ,[object Object],[object Object],[object Object],[object Object],[object Object]

C. Combined Abdomino vaginal Operations

1. Urethral Slings ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],Sling Operations

[object Object],[object Object],[object Object],[object Object],2. Needle Bladder Neck Suspension Operations

[object Object],2. Needle Bladder Neck Suspension Operations

ObTape transobturator sling ,[object Object],[object Object],[object Object],[object Object]

D. Artificial Urinary Sphincter

[object Object],[object Object],[object Object],D. Artificial Urinary Sphincter

[object Object],[object Object],[object Object]

DETRUSOR INSTABILITY ,[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],DETRUSOR INSTABILITY (DI)

TREATMENT of (DI) ,[object Object],[object Object]

[object Object],[object Object],[object Object],TREATMENT of (DI)

SURGICAL TREATMENT OF URODYNAMIC STRESS INCONTINENCE RCOG EVIDENCE BASED GUIDELINES OCTOBER 2003

Anterior vaginal repair ,[object Object],[object Object],A

[object Object],Anterior vaginal repair A

[object Object],[object Object],Anterior vaginal repair A

[object Object],[object Object],Burch colposuspension A

[object Object],[object Object],[object Object],Burch colposuspension A

[object Object],[object Object],[object Object],[object Object],Burch colposuspension A

[object Object],Burch colposuspension A

Alternative suprapubic surgery ,[object Object],B

[object Object],Marshall– Marchetti– Krantz (MMK) A

[object Object],[object Object],Marshall–Marchetti–Krantz (MMK) A

[object Object],Laparoscopic colposuspension A

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Laparoscopic colposuspension A

[object Object],[object Object],Laparoscopic colposuspension A

Needle suspension procedures ,[object Object],[object Object],A

[object Object],[object Object],Needle suspension procedures A

[object Object],[object Object],[object Object],[object Object],Needle suspension procedures A

Sling procedures ,[object Object],[object Object],C

[object Object],Sling procedures C

[object Object],[object Object],Sling procedures A

[object Object],Sling procedures A

[object Object],A Sling procedures

[object Object],[object Object],TVT A

Injectable agents ,[object Object],[object Object],B

[object Object],Injectable agents C

[object Object],[object Object],[object Object],Injectable agents C

[object Object],[object Object],Injectable agents C

Artificial sphincters ,[object Object],B

Preoperative management ,[object Object]

[object Object],Preoperative management

Urinary Incontinence

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