Lower urinary tract symptoms

Published on 09/03/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 22/04/2025

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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.

Investigation

This would depend on the history and examination.

Treatment of urinary incontinence

Aims are to:

The extent and interpretation of evaluation must be tailored to the individual. A multidisciplinary team approach optimises outcomes. Not all detected conditions can be cured and simple interventions may be effective even in the absence of a diagnosis. Many women with urinary incontinence develop undesirable bladder habits, which often exacerbate the problem and/or provoke other urinary symptoms (e.g. ‘going just in case’, voiding too often, reducing oral fluids). There is evidence to suggest that in women with mixed incontinence, detrusor overactivity should be treated prior to continence surgery, as this optimises overall outcomes.

In Australia, resources are available to women, including government-funded or subsidised schemes such as home assessments and continence products. The Continence Foundation of Australia provides a 24-hour helpline for men and women with urinary and faecal incontinence.

Overactive bladder

Urodynamic stress incontinence

Surgery

There are over 100 described surgical procedures for the management of urodynamic stress incontinence. Common complications of these procedures include voiding difficulty, injury to lower urinary tract, infection, denovo overactive bladder symptoms and failure to treat the stress incontinence. Better results have been documented for the slings and colposuspension, with an approximately 85% success rate. Commonly performed procedures today are: slings (mid-urethral, pubo-vaginal); retropubic urethropexy (Burch colposuspension, Marshall-Marshetti-Krantz (MMK)); and urethral bulking agent.