The Basic Evaluation of Urinary Incontinence. Educational Objectives. After this presentation, the participant should be able to perform an initial evaluation of a woman with urinary incontinence.
A. Urethral Hyper mobility
B. Intrinsic Sphincteric Deficiency
Displacement of urethra during sudden increase in abdominal pressure
Decreases pressure transmissionPathophysiology of Stress Urinary Incontinence
Adapted from: Weidner AC, et al. Am J Obstet Gynecol. 2001;184(2):20-27.
2. Intrinsic Sphincter Deficiency-- Sling
The real question:
Do I understand the patient’s problem well enough to formulate a reasonable treatment plan?
* output greater than 4,000 cc/24 hours
* more than 8 voids per day or 2 per night
(Wyman, Obstet Gynecol,1998)
*Leakage: 0=no leakage; 1=drops; 2=wet underwear or light pad; 3=soaked pad or clothing.
Severe Pelvic Organ Prolapse
Large Pelvic mass
Markedly decreased muscle strength
Any neurological abnormalities should receive further evaluation
Cotton swab test The Evaluation of Urinary Stress Incontinence (many years ago)
Demonstrates urethral hypermobilityOther Basic Tests
(Tapp, Ob Gyn, Jan 2005)
( International Continence Society,2003)
(Most consider a negative stress test an indication for further testing)
Eyeball cystometry The Evaluation of Urinary Stress Incontinence (many years ago)
Detects bladder (?) contractions and compliance, residual urine, and determines bladder capacity
Precedes stress test
Can not determine detrusor or urethral pressureUrodynamic Testing
Simple Cystometry The Evaluation of Urinary Stress Incontinence (many years ago)
Any leakage is considered a positive test