Abstract
Urinary incontinence is defined as the complaint of involuntary leakage of urine. Urinary incontinence impacts physical, psychological, and social well-being. In order to achieve an accurate diagnosis, a detailed history and physical exam are important. An initial evaluation should include a detailed history, urinalysis, cough stress test, evaluation of post-void residual, focused neurologic assessment, and examination for urethral hypermobility and pelvic organ prolapse. Urodynamic testing and cystoscopy may be indicated in some patients. Treatment varies based on the type of urinary incontinence and symptom severity. First-line therapy should always consist of less invasive and more conservative treatment options as they have been shown to be highly effective with minimal risk. These therapies include pelvic floor exercises, biofeedback, bladder training, weight loss, modification in fluid and caffeine intake, urethral inserts, and incontinence pessaries. Depending on the type of incontinence characterized, more invasive treatment options can be implemented if no improvement with conservative management. Typically, women with stress incontinence who have failed conservative therapies are offered surgical intervention, whereas women with urgency incontinence may be treated with pharmacologic management, intradetrusor onabotulinum toxin A, or neuromodulation. Most incontinence can be made better with available therapies.
References
Albo M, Richter H, Brubaker L, Norton P, et al. Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med. 2007;356(21):2143–55.
American College of Obstetricians and Gynecologists (ACOG). Urinary incontinence in women. Practice Bulletin No. 155. American College of Obstetricians and Gynecologists. 2015.
Balchandra P, Rogerso L. Women’s perspective: intra-detrusor botox versus sacral neuromodulation for overactive bladder symptoms after unsuccessful anticholinergic treatment. Int Urogynecol J. 2014;25(8):1059–64.
Bandukwala NQ, Gousse AE. Mixed urinary incontinence: what is first? Curr Urol Rep. 2015;16(3):9.
Blaivas J, Purohit R, Weinberger J, Tsui J, et al. Surgery after failed treatment of synthetic mesh sling complications. J Urol. 2013;190(4):1281–6.
Castro R, Arruda R, Bortolini M. Female urinary incontinence: effective treatment strategies. Climacteric. 2015;18(2):135–41.
Cespedes RD, Serkin FB. Is injection therapy for stress urinary incontinence dead? No Urology. 2009;73(1):11–3.
Chapple C, Sievert K, MacDiarmid S, Khullar V, et al. Onabotulinum toxin A 100 U significantly improves all idiopathic overactive bladder symptoms and quality of life in patients with overactive bladder and urinary incontinence: a randomised, double-blind, placebo-controlled trial. Eur Urol. 2013;64(2):249–56.
Cody J, Jacobs M, Richardson K, Moehrer B, Hextall A. Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Database Syst Rev. 2012;10:CD001405. doi:10.1002/14651858.cd001405.pub3.
Cogan SL, Weber AM, Hammel JP. Is urethral mobility really being assessed by the pelvic organ prolapse quantification (POP-Q) system? Obstet Gynecol. 2002;99(3):473–6.
Delorme E. Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol. 2001;11(6):1306–13.
Dumoulin C, Hay-Smith J, Habée-Séguin GM, Mercier J. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women: a short version Cochrane systematic review with meta-analysis. Neurourol Urodyn. 2015;34(4):300–8.
Felde G, Ebbesen MH, Hunskaar S. Anxiety and depression associated with urinary incontinence. A 10-year follow-up study from the Norwegian HUNT study (EPINCONT). Neurourol Urodynam. 2016; doi:10.1002/nau.22921.
Ford A, Rogerson L, Cody JD, Ogah J. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev. 2015;7:CD006375. doi:10.1002/14651858.cd006375.pub3.
Gaziev G, Topazio L, Lacovelli V, Asimakopoulos A, et al. Percutaneous Tibial Nerve Stimulation (PTNS) efficacy in the treatment of lower urinary tract dysfunctions: a systematic review. BMC Urol. 2013; doi:10.1186/1471-2490-13-61.
Gehrich A, Stany M, Fischer J, Buller J, Zahn C. Establishing a mean postvoid residual volume in asymptomatic perimenopausal and postmenopausal women. Obstet Gynecol. 2007;110(4):827–32.
Ghoniem G, Miller C. A systematic review and meta-analysis of Macroplastique for treating female stress urinary incontinence. Int Urogynecol J. 2013;24(1):27–36.
Haylen B, De Ridder D, Freeman R, Swift S, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29:4–20.
Jeon M, Jung H, Chung S, Sei-Kwang K, et al. Comparison of the treatment outcome of pubovaginal sling, tension-free vaginal tape, and transobturator tape for stress urinary incontinence intrinsic sphincter deficiency. Am J Obstet Gynceol. 2008;199(1):76.e1–4.
Komesu Y, Schrader R, Ketai L, Rogers R, Dunivan C. Epidemiology of mixed, stress, and urgency urinary incontinence in middle-aged/older women: the importance of incontinence history. Int Urogynecol J. 2016;27(5):763–72.
Lapitan M, Cody J. Open retropubic colposuspension for urinary incontinence in women. Cochrane Database Syst Rev. 2016;6:CD002912. doi:10.1002/14651858. CD002912.pub5.
Liao C, Kuo H. Practical aspects of Botulinum Toxin-A treatment in patients with overactive bladder syndrome. Int Neurourol J. 2015;19(4):213–9.
Lim Y, Swyer P. Effectiveness of midurethral slings in intrinsic sphincteric-related stress urinary incontinence. Curr Opin Obstet Gynecol. 2009;21(5):428–33.
Lim R, Liong M, Leong W, Khan N, Yuen K. Effect of stress urinary incontinence on the sexual function of couples and the quality of life of patients. J Urol. 2016; doi:10.1016/j.juro.2016.01.090.
Lukacz E. Treatment of urinary incontinence in women[Internet]; 2016. Available from: http://www.uptodate.com/contents/treatment-of-urinary-incontinence-in-women
McIntosh L, Andersen E, Reekie M. Conservative treatment of stress urinary incontinence in women: a 10-year (2004-2013) scoping review of the literature. Urologic Nursing. 2015;35(4):179–86.
Nager C, Brubaker L, Litman H, Zyczynski H, et al. A randomized trial of urodynamic testing before stress-incontinence surgery. Urinary Incontinence Treatment Network. N Engl J Med. 2012;366(21):1987–97.
Olivera C, Meriwether K, El-Nashar S, et al. Systematic review group for the society of gynecological surgeons. Nonantimuscarinic treatment for overactive bladder: a systematic review. Am J Obstet Gynecol. 2016; doi:10.1016/j.ajog.2016.01.156.
Peters K, Carrico D, Perez-Marrero R, et al. Randomized trial of percutaneous tibial nerve stimulation versus sham efficacy in the treatment of overactive bladder syndrome: results from the SUMIT trial. J Urol. 2010;183(4):1438–43.
Rehman H, Berzerra C, Bruschini H, Cody J. Traditional suburethral sling operations for urinary incontinence in women. Cochrane Database Syst Rev. 2011;1:CD001754. doi:10.1002/14651858.CD001754.pub3.
Reynolds W, Dmochowski R. Urethral bulking: a urology perspective. Urol Clin North Am. 2012;39(3):279–87.
Richter H, Albo M, Zyczynski H, Kenton K, et al. Urinary incontinence treatment network. Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med. 2010;362(22):2066–76.
Schierlitz L, Dwyer P, Rosamilia A, Murray C, et al. Effectiveness of tension-free vaginal tape compared with transobturator tape in women with stress urinary incontinence and intrinsic sphincter deficiency: a randomized controlled trial. Obstet Gynecol. 2008;112(6):1253–61.
Singh E, El Nashar A, Trabuco E, et al. Comparison of short term outcomes of sacral nerve stimulation and intradetrusor injection of Onabotulinum toxin A (Botox) in women with refractory overactive bladder. Female Pelvic Med Reconstr Surg. 2015;21(6):369–73.
Sirls L, Foote J, Kaufman J, Lightner D, et al. Long-term results of the FemSoft urethral insert for the management of female stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(2):88–95.
Staskin D, Hilton P, Emmanuel A, et al. Initial assessment of incontinence. In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence: 3rd international consultation on incontinence. Paris: Health Publications Ltd; 2005. p. 485.
Swierzewski S, McGuire E. Pubovaginal sling for treatment of female stress urinary incontinence complicated by urethral diverticulum. J Urol. 1993;149(5):1012–4.
Ulmsten U, Henriksson L, Johnson P, Varhos G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 1996;7(2):81–5.
Vissers D, Neels H, Vermandel A, De Wachter S, et al. The effect of non-surgical weight loss interventions on urinary incontinence in overweight women: a systematic review and meta-analysis. Obes Rev. 2014;15(7):610–7.
Walters M, Karram M. Urogynecology and reconstructive pelvic surgery. 4th ed. Philadelphia: Saunders Elsevier; 2015.
Wing R, West D, Grady D, Creasman J, et al. Effect of weight loss on urinary incontinence in overweight and obese women: results at 12 and 18 months. Program to reduce incontinence by diet and exercise group. J Urol. 2010;184(3):1005–10.
Yamanishi T, Kaga K, Fuse M, Shibata C, Uchiyama T. Neuromodulation for the treatment of lower urinary tract symptoms. Low Urin Tract Symptoms. 2015;7(3):121–32.
Zyczynski H, Lloyd L, Kenton K, Menefee S, et al. Correlation of Q-tip values and point Aa in stress-incontinent women. Urinary Incontinence Treatment Network (UITN). Obstet Gynecol. 2007;110(1):39–43.
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Rolston, R., Özel, B. (2017). Urinary Incontinence: Diagnosis, Treatment, and Avoiding Complications. In: Shoupe, D. (eds) Handbook of Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-319-17002-2_71-1
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DOI: https://doi.org/10.1007/978-3-319-17002-2_71-1
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Urinary Incontinence: Diagnosis, Treatment, and Avoiding Complications- Published:
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DOI: https://doi.org/10.1007/978-3-319-17002-2_71-2
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DOI: https://doi.org/10.1007/978-3-319-17002-2_71-1