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Urinary Incontinence
Urodynamic Stress Incontinence
a report by
Sushma Srikrishna,
1
Dudley Robinson
2
and Linda Cardozo
3
1. Sub-speciality Trainee in Urogynaecology; 2. Consultant Obstetrician and Urogynaecologist;
3. Professor of Urogynaecology, Department of Urogynaecology, King’s College Hospital, London
Urinary incontinence, the ‘complaint of any involuntary leakage of Frequency–Volume Charts
urine’,
1
is a common and distressing condition known to adversely affect While a clinical interview may provide information on the voiding habits
quality of life (QoL).
2
While the prevalence of urinary incontinence has of a patient, the impression of symptom severity obtained is largely
been found to vary widely depending on the definition used, a recent subjective and to some extent retrospective. The frequency–volume chart
large-scale epidemiological study found that approximately 25% of (urinary or bladder diary) provides an objective assessment of a patient’s
women complain of urinary leakage.
3
The financial burden of fluid intake and urine output.
incontinence is also considerable. In 1998, the annual economic cost was
projected to be approximately £354 million.
4
Worldwide, the situation is Pad Test
similar, with US$26 billion being spent per annum in the US alone.
5
A simple way of verifying urinary leakage and the quantity of urine lost is
to compare the difference in weight of a perineal pad before and after use.
Prevalence This is usually performed with a standardised volume of fluid in the bladder
Estimates of prevalence vary according to different populations studied, over a pre-determined time period or as a home test over 24–48 hours.
methods used for investigation and the definition used. While the precise
number of women complaining of urinary incontinence remains unknown, Urodynamic Investigations
there have been several large-scale studies over the last 20 years. The
prevalence of urinary incontinence was assessed in a large unselected female Uroflowmetry
population in Norway. All women aged 20 years and over were invited to A simple and non-invasive measurement of urine flow is uroflowmetry.
participate, of whom 27,936 of 34,755 (80%) completed the questionnaire. To obtain a representative record of flow parameters, the woman is
Overall, 25% of women complained of urinary leakage and 7% had asked to void in private when her bladder is comfortably full. Several
significant leakage, which was defined as moderate or severe incontinence types of flow meter can be used, but the most common are those with
that was considered troublesome. Stress incontinence accounted for 50% either a strain gauge weighing transducer placed under a receptacle into
of cases, urge incontinence 11% and mixed incontinence 36%.
3
When which the woman voids, or devices with a disc that rotates at a speed
considering stress incontinence in the age group between 20 and 34 years, dependent upon the flow of urine.
7
The maximum flow rate and volume
the relative risk (RR) was 2.7 (95% confidence interval (CI) 2.0–3.5) for voided are recorded, and an estimation of the post-micturition residual
primiparous women and 4.0 (95% CI 2.5–6.4) for multiparous women.
6
determined by either catheterisation or ultrasound.
Urodynamic Stress Incontinence
Sushma Srikrishna is a Sub-speciality Trainee in Urogynaecology in the Department of
Stress urinary incontinence describes a symptom, a sign and a diagnosis,
Urogynaecology at King’s College Hospital, London. Her research interests include the
achievement of patient-orientated goals in pelvic floor dysfunction surgery. She has worked in
although it is only following urodynamic investigation that a diagnosis of
the UK since 1999, prior to undertaking a research fellowship with Professor Linda Cardozo in
urodynamic stress incontinence can be made. This condition is defined as
the Department of Urogynaecology at King’s College Hospital, London. Dr Srikrishna trained
at the Lokmanya Tilak Medical College at the University of Bombay in India, qualifying MBBS
‘the involuntary leakage of urine during increased abdominal pressure in
in 1995 and completed post-graduate studies in obstetrics and gynaecology in 1998.
the absence of a detrusor contraction’.
1
While incontinence associated
with coughing, sneezing or exercising is the predominant symptom,
Dudley Robinson is a Consultant Obstetrician and
women may also complain of frequency, urgency and urge incontinence.
Gynaecologist with a sub-speciality interest in
The aetiology of urodynamic stress incontinence is complex and remains
urogynaecology in the Department of Urogynaecology at
King’s College Hospital, London. He has published widely in
poorly understood. Several pathological processes have been implicated,
the field of urogynaecology and his research interests
including intrinsic sphincter deficiency, bladder neck hypermobility, include the effect of hormones and drugs on the lower
reduced pressure transmission to the proximal urethra, changes in
urinary tract. Dr Robinson trained at the Royal London
Hospital, qualifying MBBS in 1991.
collagen and the development of a neuropathy, in addition to oestrogen
deficiency following the menopause (see Table 1).
Linda Cardozo is Professor of Urogynaecology and Head of
the Urogynaecology Department at King’s College Hospital,
Basic Investigations London. She has a large clinical workload dealing with
complex urogynaecological problems in a supra-regional
tertiary referral unit teaching medical students, training
Mid-stream Urine Sample
junior doctors and undertaking clinical research. Professor
Urinary tract infection (UTI) may cause or exacerbate lower urinary tract
Cardozo is involved in the managerial leadership of many
national and international scientific societies.
symptoms. The results of urodynamic investigations will also be
invalidated if tests are performed when the patient has a UTI.
© TOUCH BRIEFINGS 2007 73
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