A presentation about Urinary Stress Incontinence.

1. Urinary Stress
Incontinence
Dr. NOBODY
DGO Student

2. Stress urinary incontinence
•According to International Continence Society
(ICS) it is defined as involuntary urethral loss of
urine when the intravesical pressure exceeds the
maximum urethral pressure in the absence of
detrusor activity.

3. Incidence
•SUI is the commonest type of incontinence in
women.
40% western countries
5% symptoms maybe annoying

4. Pathophysiology
• Urethral hypermobility (80%)
Due to descent of the bladder neck and proximal
urethra.
• Intrinsic Sphincter deficiency (20%)

6. Grading of SUI
• Grade 0: Incontinence without leakage.
• Grade 1: Incontinence with stress and little
descent.
• Grade 2: Incontinence with stress and with 2cm
descent.
• Grade 3: Neck and urethra wide open even
without bladder contraction.

7. Causes of -SUI
Urethral
hypermobility
Urethral
scarring
Raised IAP
1. Urogenital prolapse
2. Pelvic floor damage
or denervation
3. Parturation
4. Pelvic surgery
5. Menopause.
1. Vaginal surgery
2. Incontinence
surgery
3. Urethral
dilatation or
urethrotomy
4. Recurrent UTI
5. Radiotherapy
1. Pregnancy
2. Chronic cough
3. Abdominal /
pelvic mass
4. Faecal
impaction
5. Ascites
(obesity)

8. SUI- Patient Profile
1. Age: Postmenopausal
2. Parity: Usually parous
3. Obesity :BMI >30
4. Medical History: Diabetes, chronic
pulmonary disease, neurological disease
5. Drug History: Sedative and anti psychotic.
6. Surgical History: Anterior colporrhaphy,
VVF repair.

9. SUI - Symptoms
1. Escape of urine with coughing, sneezing or
laughing.
2. Leakage: Small.
3. No frequency and urgency.
4. Fully aware of leakage.
5. Rest and Sleep: No leakage.
6. Dysuria.

10. Local Examination
1. Urinary cough stress test:
Patient asked to cough to see the escape of urine
in full bladder.
2. Bonney’s Test:
To see the patency of internal sphincter to control
incontinence

11. 3. Q-tip Test:
If there is marked upward elevation of
the cotton tipped swab (>30) , urethra is
considered hypermobile.

13. Investigations
1. Mid stream urine analysis: Normal
2. Frequency- volume chart (Urinary diary):
To see intake,output, number of voids per
day,functional bladder capacity.
3. Pad Test: If the weight gain of pad is >1gm, it
indicates SUI.

14. 4. Urodynamic Study:
 Uroflowmetery: Normal.
 Cystometery: Normal.
 Video cystourethrography(VCU)

15. Uroflowmetery

16. Cystometery

17. 5. Urethral Pressure Profilometry: Significant
lowering of urethral closure pressure during
strain.
6. Post-void residual urine (PVR) : Normal
7. Leak-point Pressure test: Positive
8. Intravenous Urography (IVU)
9. Transvaginal endosonography.

19. Thank You