Male and Female Incontinence PDF

Male and Female Incontinence Cevdet Kaya MD. Prof. Department of Urology Istinye University School of Medicine Definition Incontinence... Continence is the ability to hold urine, and to be able to urinate at the appropriate time and place Incontinence is the involuntary loss of urine The prevalen...

Male and Female Incontinence Cevdet Kaya MD. Prof. Department of Urology Istinye University School of Medicine Definition Incontinence... Continence is the ability to hold urine, and to be able to urinate at the appropriate time and place Incontinence is the involuntary loss of urine The prevalence in the elderly population is 35%; more than 20% for men and 55% for women Related with deterioration in quality of life, psychological stress, social isolation and depression Voiding Physiology Filling and storage phase (Symphatetic nervous system) Intra-vesical pressure is low Bladder outflow is closed Normally no involuntary bladder contractions Voiding (emptying phase) (Parasymphatetic nervous system) Contraction in the detrusor muscle Relaxation of sphincters Voiding Physiology The voiding center To prevent contraction of the detrusor muscle by sending inhibitory signals To store the urine until the desired micturation time Aging The frequency of involuntary bladder contraction increases, bladder capacity is reduced Urethral pressure decreases Bladder contractility decreases The incidance of nocturia increases BPH in men, menopausal estrogen reduction Urodynamics Causes of Incontinence Aging UTI Neurological diseases BPH Menopause Diabetes Surgery Overactive bladder Constipation Incontinence Types Urge incontinence Urgency, sudden strong desire of pee, pollakuria , overactive bladder, involuntary bladder contractions, neurogenic bladder or infection, tumor or stone, BPH Stress urinary incontinence more frequent in women, incontinence with intraabdominal pressure increase, coughing, laughing, sneezing or incontinence during exercise, due to urethral hypermobility caused by weakening of the pelvic floor muscles, weak pelvic floor, also occur as a result of intrinsic sphincter failure related to trauma, radiation or surgery Mixed urinary incontinence (stress and urge, but dominancy?) Total urinary incontinence (sphincteric falure) Overflow incontinence (after retention) Outflow obstruction, BPH, tumor, stricture, neurological, spinal cord lesions, pelvic surgery, pharmacological, detrusor hypoactivity, DM, chronic alcoholism etc Anatomy Evaluation Symptoms and quality of life Type of incontinence and possible etiologies History (duration of symptoms, UTI, stone, previous urinary, pelvic or spinal surgery procedures, DM, constipation, drugs used and other non-pharmaceutical substances, neurological pathology, BPH, pregnancy in women, number of births, delivery type, relationship between onset of symptoms and delivery and menopause Physical examination (including genitalia and neurological, anal tonus, bulbocavernous reflex, stress test) Laboratory Imaging Urodynamic studies Treatment According to the type of incontinence Behavioural modality Lifestyle changes, coffee and water restriction, lose weight, voiding diary, double and timed voiding, pelvic floor exercise (Kegel), biofeedback, vaginal weights Pharmacological treatment Antimuscarinics (anticholinergics), mirabegron, Tricyclic antideppresants, imipramine, oestrogen Surgical treatment Transobturator tape and tension free tape, sling operations