Chapter 17 Lower urinary tract symptoms
Urinary incontinence is the complaint of involuntary urinary leakage. Lower urinary tract symptoms include complaints regarding urinary storage, voiding or postmicturition symptoms. When a woman presents with urinary symptoms, a detailed history on lower urinary tract symptoms is required.
History
• daytime frequency (normally up to 8 times a day): increased frequency is associated with increased fluid intake, detrusor overactivity, poor bladder compliance or increase in bladder sensation
Investigation
This would depend on the history and examination.
• bladder diary
Further evaluation
Urodynamic assessment
• Cystometry is a test of detrusor function consisting of an observation and/or recording of the pressure/volume relationship during bladder filling.
Treatment of urinary incontinence
Overactive bladder
• overactive bladder is a symptom complex: urgency with or without urge incontinence, usually associated with frequency and nocturia
• detrusor overactivity
• overactive bladder survey in Europe and USA: about 17% of women with symptoms suggestive of overactive bladder; increasing prevalence with increasing age
Overactive bladder and idiopathic detrusor overactivity
The mainstay of treatment is non-surgical.
• pharmacological
• major portion of neurohumoral stimulus for physiological bladder contraction is acetylcholine-induced stimulation of postganglionic parasympathetic cholinergic receptor sites on bladder smooth muscle
Urodynamic stress incontinence
Surgery
Slings
• In the mid-1990s the mid-urethral sling was described, which allowed minimally invasive surgery, reduced hospital stays and a quicker return to daily activities, without a reduction in success rates.