Ebook Williams gynecology (Second edition): Part 2
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Ebook Williams gynecology (Second edition): Part 2
SECTION 3FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERYCHAPTER 23Urinary IncontinenceDEFINITIONS.................................606EPIDEMIOLOGY... Ebook Williams gynecology (Second edition): Part 2 ..............................607RISKS FOR URINARY INCONTINENCE............,607PATHOPHYSIOLOGY ..!..................1......609BLADDER FILLING ...?...I..........I.........609BLADDER EMPTYING............................611CONTINENCE THEORIES.........................615DIAGNOSIS........................ Ebook Williams gynecology (Second edition): Part 2 ...........616HISTORY.....................................616PHYSICAL EXAMINATION........................618DIAGNOSTIC TESTING .......................Ebook Williams gynecology (Second edition): Part 2
...618TREATMENT...................................624CONSERVATIVE/NONSURGICAl ....................624TREATMENT OF STRESS URINARY INCONTINENCE625TREATMSECTION 3FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERYCHAPTER 23Urinary IncontinenceDEFINITIONS.................................606EPIDEMIOLOGY... Ebook Williams gynecology (Second edition): Part 2 leakage of urine. In addition to the utethra. urine may also leak from cxtraurcthral sources, such as fistulas or congenital malformations of the lower urinary tract. Although incontinence iscategorized into a number of forms, this chapter will focus on the evaluation and management of stress and u Ebook Williams gynecology (Second edition): Part 2 rge urinary incontinence. Stress urinary incontinence (SUI) is the involuntary leakage of urine with exertion or with sneezing or coughing. Urge urinaEbook Williams gynecology (Second edition): Part 2
ry or "urge"—incontinence is the involuntary leakage accompanied or immediately preceded by a perceived strong imminent need to void. A related conditSECTION 3FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERYCHAPTER 23Urinary IncontinenceDEFINITIONS.................................606EPIDEMIOLOGY... Ebook Williams gynecology (Second edition): Part 2 rams. 2009).According to International Continence Society guidelines, urinary incontinence is a symptom, a sign, and a condition (Abrams. 2002). For example, with SƯI, a patient may complain of involuntary urine leakage with exercise or laughing. Concurrent with these symptoms, involuntary leakage f Ebook Williams gynecology (Second edition): Part 2 rom the urethra synchronous with cough or Valsalva may be observed during examination by a provider. And as a condition. SƯ1 is objectively demonstratEbook Williams gynecology (Second edition): Part 2
ed during urodynamic testing if involuntary leakage of urine is seen with increased abdominal pressure arid absence of detrusor muscle contraction. UnSECTION 3FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERYCHAPTER 23Urinary IncontinenceDEFINITIONS.................................606EPIDEMIOLOGY... Ebook Williams gynecology (Second edition): Part 2 own as genuine rtress incontinence, is used.With urge urinary incontinence, women have difficulty postponing urination urges and generally must promptly empty their bladder on cue and without delay. If urge urinary incontinence is objectively demonstrated during urodynamic testing with cystomctric e Ebook Williams gynecology (Second edition): Part 2 valuation, the condition is termed detrusor ovenutivity (DO), formerly known as detrusor instability. When both stress and urgency components arc presEbook Williams gynecology (Second edition): Part 2
ent, it is called mixed urinary incontinence.h'unerional incontinence occurs in situations in which a woman cannot reach a toilet in time because of pSECTION 3FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERYCHAPTER 23Urinary IncontinenceDEFINITIONS.................................606EPIDEMIOLOGY... Ebook Williams gynecology (Second edition): Part 2 YIn Western societies, epidemiologic studies indicate a prevalence of urinary incontinence of 15 to 55 percent. Ihis wide range is attributed to variations in research methodologies, population characteristics, and definitions of incontinence. As pait of the 2005-2006 National Health and Nutrition E Ebook Williams gynecology (Second edition): Part 2 xamination Survey (NHANES). a cross-sectional group of 1%1 nonpregnant, noninstitutionalized women in the United States were questioned about pelvic fEbook Williams gynecology (Second edition): Part 2
loor disorders. Urinary incontinence that was characterized by participants as moderate to severe leakage was identified in 15.7 percent (Nygaard. 200SECTION 3FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERYCHAPTER 23Urinary IncontinenceDEFINITIONS.................................606EPIDEMIOLOGY... Ebook Williams gynecology (Second edition): Part 2 stimated that only one in four women will seek medical advice for incontinence due to embarrassment, limited access to health care, or poor screening by health care providers (Hagstad. 1985).Among ambulator)' women with urinary incontinence, the most common condition is SUI, which represents 29 to 7 Ebook Williams gynecology (Second edition): Part 2 5 percent of cases. Urge urinary incontinence accounts for up to 33 percent of incontinence eases, whereas the remainder is attributable to mixed formEbook Williams gynecology (Second edition): Part 2
s (Hunskaar. 2000). In a review of overactive bladder, 15 percent of 64,528 women met criteria for overactive bladder with or without incontinence, anSECTION 3FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERYCHAPTER 23Urinary IncontinenceDEFINITIONS.................................606EPIDEMIOLOGY... Ebook Williams gynecology (Second edition): Part 2 ed social relationships, psychological distress from embarrassment and frustration, hospitalizations due to skin breakdown ansi urinary tract infection, andnursing home admission. An incontinent elderly woman is 2.5 times more likely to be admitted to a nursing home than a continent one (l.anga. 200 Ebook Williams gynecology (Second edition): Part 2 2). Likewise, the monetary ramifications of incontinence are considerable. An estimated $32 billion is spent annually in the United States caring forEbook Williams gynecology (Second edition): Part 2
community-dwelling and institutionalized patients with urinary incontinence (Hu, 2004). Moreover, population projections from the U.S. Census Bureau fSECTION 3FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERYCHAPTER 23Urinary IncontinenceDEFINITIONS.................................606EPIDEMIOLOGY... Ebook Williams gynecology (Second edition): Part 2 Wu. 2009).RISKS FOR URINARY INCONTINENCEAgeIhc prevalence of incontinence appears to increase gradually during young adult life (Fig. 23-1). A broad peak is noted at middle age and then steadily increases after age 65 (Hanne-stad, 2000). Similarly, data from the 2005-2006 NHANES demonstrate a steady Ebook Williams gynecology (Second edition): Part 2 increase in incontinence prevalence with age: 7 percent in those aged 20 to 40 years, 17 percent for ages 40 to 60, 23 percent for ages 60 to 80, andEbook Williams gynecology (Second edition): Part 2
32 percent for those older than 80 (Nygaard. 2008).Incontinence should not be viewed as a normal consequence of aging. However, several physiologic aSECTION 3FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERYCHAPTER 23Urinary IncontinenceDEFINITIONS.................................606EPIDEMIOLOGY... Ebook Williams gynecology (Second edition): Part 2 e of involuntary detrusor contractions increases with age, and detrusor overactivity is found in 21 percent of healthy.SECTION 3FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERYCHAPTER 23Urinary IncontinenceDEFINITIONS.................................606EPIDEMIOLOGY...Gọi ngay
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