Mixed Urinary Incontinence: Pathogenesis and Clinical Findings
Urgency Urinary Incontinence (UUI) -> Urinary leakage preceded by a sudden, strong urge to void
-> Overflow Incontinence -> Overfilling of the bladder from obstruction; BOO (tumour, stone, BPH, urethral or bladder neck stricture)
-> Detrusor Overactivity -> OAB (idiopathic), CNS lesion (neurogenic), inflammation/ infection (cystitis, UTI), diabetes mellitus
-> Bladder Wall Compliance ->
Progressive increase in intravesicle pressure during bladder filling pushing urine from the bladder
Stress Urinary Incontinence (SUI) -> Episodic involuntary urinary leakage with sudden increase in intra-abdominal pressure -> Urethral hypermobility, intrinsic sphincter deficiency, or a poorly coapting urethra -> Decreased Pelvic floor muscle and ligament strength causing Decreased tone of vesicoureteral sphincter unit; Decreased urethral strength and associated striated and smooth muscle; iatrogenic
- Failure to Void - Weak Stream (+/- dribbling), Intermittent, Straining, Incr PVR if a complication of urinary retention; obstruction visible on cystoscopy
- Failure to Store - Frequency, Urgency, Nocturia, Dysuria if SUI or UUI not caused by obstruction
- Urodynamic Studies - SUI — Decr urethral closure pressure with incr IAP/Bladder Volume and urinary leakage. UUI— involuntary detrusor contraction and/or detrusor sphincter dyssynergia
#Urinary #Incontinence #Mixed #Pathophysiology #Signs #Symptoms #Urology #Diagnosis
Types of Urinary Diversion Procedures
Ileal Conduit:
• Technically simpler, fewer complications, and well understood. No bladder retraining, No nocturnal, incontinence
• Stomal complications (hernias), Urinary incontinence, Long-term stomal care expenses
Continent Urinary diversion. E.g.: Indiana Pouch:
• Normal to near-normal urinary continence, Stoma can be covered with band-aid. No bag. No nocturnal incontinence
• Technically difficult surgery. Stomal complications. Intermittent catheterization issues. Complications of waste product absorption
Orthotopic Neobladder:
• Normal to near-normal urinary continence. No stoma. Better physical image. Better post operative sexual function
• Technically difficult surgery. Postop bladder training. Nocturnal incontinence Complications of waste product absorption
- Dr. Sudha Mannemuddhu @drM_sudha
#Urinary #Diversion #Procedures #Types #Comparison #Management #Urology #Neobladder
Types of Urinary Incontinence and Their Management:
The various types of urinary incontinence, along with the usual approaches used in the management of each: Stress, Urge, Mixed, Overflow, Functional
#Diagnosis #Management #Urinary #Incontinence #Types #Comparison #Table #Stress #Urge #Overflow #Neurogenic
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