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
