DIAGNOSIS OF STRESS URINARY INCONTINENCE

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ETIOLOGY

SUI is defined as the involuntary loss of urine, occurring with increases in intra-abdominal pressure but without change in detrusor pressure, that causes a social problem for the patient. Urinary control results from a combination of forces that includes consideration of the anatomy of pelvic support, the intrinsic urethral mechanism, neurophysiology, and hormonal changes. Increases in intra-abdominal pressures are counteracted by four compensatory mechanisms that allow continence to be

CLASSIFICATION OF SUI

SUI may occur with or without associated anatomic changes of the sphincteric unit. SUI with anatomic changes is referred to as anatomic incontinence (AI). On the other hand, intrinsic sphincter deficiency (ISD) is severe SUI associated with damage or malfunction of the intrinsic sphincteric unit (a bad urethra) that can occur with or without anatomic changes. This can result from radiation, trauma, multiple surgeries, hormonal deprivation, or neurogenic dysfunction (meningo-myelocele/sacral arc

History

The evaluation of patients with urinary incontinence begins with a complete history. We ask our patients to respond to a detailed questionnaire that encompasses symptomatology; gynecologic and obstetric history (protracted or traumatic labor and increased birth weight); previous surgery; bowel and sexual function; other medical and neurologic disorders; medications; pad usage; and impact on lifestyle. Completion of this questionnaire in a relaxed home setting gives patients the opportunity to

VCUG

The VCUG is used to evaluate the bladder neck position; the bladder base (cystocele); the level of continence (bladder neck versus midurethral); and to attempt visual confirmation of stress incontinence (Fig. 1). The main problem in assessing the bladder neck with a VCUG is that detrusor pressures are unknown and thus the results should be interpreted with suspicion. Videourodynamics is the best method of evaluating the competence of the bladder neck.

Vesicoureteral reflux, evidence of bladder

SEAPI

SEAPI is an acronym for Stress incontinence, Emptying ability, Anatomy, Protection, and Instability. This staging classification system is similar to the TNM tumor staging classification system in that each component is graded with a score from 0 (no symptoms) to 3 (severe symptoms). After completion of the evaluation of the incontinent patient, a preoperative subjective and objective SEAPI score is determined (Tables 1 and 2). These scores are then compared with postoperative SEAPI scores to

CONCLUSION

The diagnosis of SUI requires a multifocal approach. Because urinary leakage is amenable to treatment in the majority of cases, identifying the underlying pathophysiology is important. The key to the approach involves distinguishing sphincteric incontinence from that owing to detrusor instability. We do not advocate that patients who first present with uncomplicated signs and symptoms of SUI undergo sophisticated testing. In complex cases, however, when there is a known or suspected neurologic

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    Neurourol Urodyn

    (1989)
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Address reprint requests to Shlomo Raz, MD Department of Urology UCLA School of Medicine 924 Westwood Boulevard Suite 520 Los Angeles, CA 90024

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