Urinary incontinence
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Urinary incontinence
- 1. Guided By Dr. Pratiksha Gupta Presented By Dr. Jograjiya Department of Obstetrics and Gynecology ESIC-PGIMSR, Basaidarapur, New Delhi-110015.
- 18. D Delirium I Infection A Atrophic urethritis and vaginitis P Pharmacologic causes P Psychological causes E Excessive urine production R Restricted mobility S Stool impaction Resnick NM, Yalla SV. Management of urinary incontinence in the elderly. N Engl J Med 1985;313:800–805.
- 26. The internal urethral sphincter (bladder sphincter)
- 31. The external urethral sphincter
- 39. AETIOLOGY In fact vaginal delivery is the commonest cause of stress incontinence.
- 40. AETIOLOGY
- 41. AETIOLOGY
- 44. A) Urethral hypermobility (80 - 90%)
- 49. Denervation and/or Devascularization scarring of the urethra and its supporting tissue “Lead pipe” Urethra Which lead to
- 56. 3. Yousef Test
- 63. Cystometrogram
- 64. Cystometrogram
- 70. ApproximateNormalValues of FemaleBladder Function • Residual urine <50 mL • First desire to void occurs between 150 and 250 mL infused • Strong desire to void does not occur until after 250 mL • Cystometric capacity between 400 and 600 mL • Bladder compliance between 20 and 100 mL/cm H2O measured 60 sec after reaching cystometric capacity • No uninhibited detrusor contractions during filling, despite provocation • No stress or urge incontinence demonstrated, despite provocation • Voiding occurs as a result of a voluntarily initiated and sustained detrusor contraction • Flow rate during voiding is >15 mL/sec with a detrusor pressure of <50 cm H2O Wall LL, Norton P, Delancey J. Practical urogynecology. Baltimore, MD: Williams & Wilkins, 1993.
- 74. 9. Measurement of Urethral Pressure
- 76. 10. Measurement of Urethral Length
- 77. 11. Uroflowmetry
- 79. 12. Sonographic
- 83. What laboratory tests are helpful in evaluating incontinence?
- 90. Conservative treatment cures or improves 50% of cases and include:
- 94. 1. Kelly operation 1914
- 98. 3. Vaginal tape operation (TVT)
- 99. Tension free Vaginal Tape (TVT)
- 105. The incision is made in the rectus fascia. The fascia is excised.
- 118. Sling Operations
- 119. 2. Needle Bladder Neck Suspension Operations
- 120. An example is Stamey operation in which two Dacron tubes (1 cm) are used to give support to the bladder neck and to avoid the sutures cutting through the tissues. 2. Needle Bladder Neck Suspension Operations
- 123. D. Artificial Urinary Sphincter
- 129. TREATMENT of (DO)
- 137. A
- 138. A
- 139. A
- 140. A
- 141. A
- 147. B
- 148. A
- 149. A
- 150. A
- 151. A
- 152. A
- 155. A
- 156. A
- 157. A
- 158. A
- 159. C
- 160. Sling procedures C
- 161. A
- 162. A
- 163. Sling procedures A
- 164. Sling procedures A
- 165. Sling procedures A
- 166. Sling procedures A
- 167. A Sling procedures
- 168. Sling procedures A
- 169. Sling procedures A
- 170. TVT A
- 171. TVT A
- 172. TVT A
- 173. TVT A
- 174. A TVT
- 175. B
- 176. C
- 177. C
- 178. C
- 179. C
- 180. Bulking agents C
- 181. B
- 185. Procedure The median cure/dry rates at 48 months and longer colposuspension 84% Minimal invasive transobturator sling procedures 83% transvaginal needle suspensions 67% anterior colporrhaphy 61%
Editor's Notes
- The bladder dome is rich in parasympathetic muscarinic receptors (M) and sympathetic -adrenergic receptors ∝. The bladder neck contains a greater density of sympathetic -adrenergic receptors 𝛽.
- The inferior hypogastric plexus, also known as the pelvic plexus, is formed by visceral efferents from S2 to S4, which provide the parasympathetic component by way of the pelvic nerves. The superior hypogastric plexus primarily contains sympathetic fibers from the T10 to L2 cord segments and terminates by dividing into right and left hypogastric nerves. The hypogastric nerves and rami from the sacral portion of the sympathetic chain contribute the sympathetic component to the pelvic plexus. The pelvic plexus divides into three portions according to the course and distribution of its fibers: the middle rectal plexus, uterovaginal plexus, and vesical plexus.
- Physiology of urine storage. Bladder distension from filling leads to: (1) -adrenergic contraction of the urethral smooth muscle and increased tone at the vesical neck (via the T11-L2 spinal sympathetic reflex); (2) activation of urethral motor neurons in Onuf nucleus with contraction of striated urogenital sphincter muscles (via the pudendal nerve); and (3) inhibited parasympathetic transmission with decreased detrusor pressure. alpha adrenergic receptors; beta adrenergic; M muscarinic (cholinergic).
- Onuf nucleus is found in the ventral horn gray matter of S2 through S4. This nucleus contains the neurons whose fibers supply the striated urogenital sphincter. The urethrovaginal sphincter and compressor urethrae are innervated by the perineal branch of the pudendal nerve. The sphincter urethrae is variably innervated by somatic efferents that travel in the pelvic nerves.
- Physiology of urine evacuation. Efferent impulses from the pontine micturition center results in inhibition of somatic fibers in Onuf nucleus and voluntary relaxation of the striated urogenital sphincter muscles. These efferent impulses also result in preganglionic sympathetic inhibition with opening of the vesical neck and parasympathetic stimulation, which results in detrusor muscarinic contraction. The net result is relaxation of the striated urogenital sphincter complex causing decreased urethral pressure, followed almost immediately by detrusor contraction and voiding. alpha adrenergic receptors; beta adrenergic; M muscarinic (cholinergic).
- Striated urogenital sphincter anatomy. The perineal membrane is removed to show the three component muscles of the striated urogenital sphincter. This sphincter receives most of its somatic innervation through the pudendal nerve.
- (Fig. 23-9). In women who are hypoestrogenic, this submucosal vasculature plexus is less prominent. In part, hormone replacement targets this diminished vascularity and enhances coaptation to improve continence.
- Interpretation of multichannel urodynamic evaluation: cystometrogram. A catheter is placed in the bladder to determine the pressure generated within it (Pves). The pressure in the bladder is produced from a combination of the pressure from the abdominal cavity and the pressure generated by the detrusor muscle of the bladder. Bladder pressure (Pves) pressure in abdominal cavity (Pabd) detrusor pressure (Pdet). A second catheter is placed in the vagina (or rectum if advanced-stage prolapse is present) to determine the pressure in the abdominal cavity (Pabd). As room-temperature saline is instilled into the bladder, the patient is asked to cough every 50 mL and the external urethral meatus is observed for leakage of urine around the catheter. The volume at first desire to void and the bladder capacity is recorded. Additionally, the detrusor pressure (Pdet) channel is observed for positive deflections to determine if there is detrusor activity during testing. The detrusor pressure (Pdet) cannot be measured directly by any of the catheters. However, from the first equation, we can calculate the detrusor pressure (Pdet) by subtracting the abdominal pressure (Pabd) from the bladder pressure (Pves): Detrusor pressure (Pdet) bladder pressure (Pves) pressure in abdominal cavity (Pabd) I. Urodynamic Stress Incontinence (USI) Urodynamic stress incontinence is diagnosed when urethral leakage is seen with increased abdominal pressure, in the absence of detrusor pressure. a. USI (Column 1): Abdominal pressure is generated with Valsalva maneuver or cough. This pressure is transmitted to the bladder, and a bladder pressure (Pves) is noted. The calculated detrusor pressure is zero. Leakage is observed, and diagnosis of USI is assigned. b. No USI (Column 2): Abdominal pressure is generated with Valsalva maneuver or cough. This pressure is transmitted to the bladder, and a bladder pressure (Pves) is noted. The calculated detrusor pressure is zero. Leakage is not observed. The patient is not diagnosed as having USI. II. Detrusor Overactivity (DO) Detrusor overactivity is diagnosed when the patient has involuntary detrusor contractions during testing with or without leakage. a. DO (Column 3): Although no abdominal pressure is observed, a vesicular pressure is noted. A calculated detrusor pressure is recorded and noted to be present. A diagnosis of DO is made regardless of whether leakage is seen. b. DO (Column 4): In this example, an abdominal pressure is observed as well as a vesicular pressure. Using only the Pabd and the Pves channels, it is difficult to tell whether or not the detrusor muscle contributed to the pressure generated in the bladder. On subtraction, a calculated detrusor pressure is recorded. Thus, a diagnosis of DO is made, again regardless of whether leakage is seen. In addition to these channels, occasionally a channel to detect electromyographic activity is used. Pabd pressure in abdominal cavity; Pdet detrusor pressure (calculated); Pves bladder pressure.