Urodynamics
Characteristics Standard urodynamics (SU) Ambulatory urodynamic monitoring (AUM) Environment Lab with limited privacy Outside of a lab with less privacy issues Test length 30–90 min 3–24 h Patient position Variable…
Clinical Evaluation of the Patient Who Requires Urodynamics
Both Male Female General mental status Body mass index Dexterity and mobility Abdomen, flank Skin Perineum Genitals Penis Vaginal half-speculum exam Scrotum Bimanual pelvic and anorectal Testicles Stress test for…
Assessment of Urinary Incontinence
Fig. 3.1 International prostate symptom score (IPSS) Medication history: Many medications can affect LUTS and incontinence. Beware of polypharmacy (especially in the elderly) as well as diuretics and alpha-antagonists that…
The Patient with Neurological Problems
Level of injury Common causes LUT dysfunction Management Suprapontine lesion CVA, Parkinson’s disease, hydrocephalus, subdural hemorrhage Detrusor overactivity with coordinated micturition Anticholinergics Frequency, urgency, and urgency incontinence Suprasacral lesion Spinal…
The Male Patient
Urinary retention Recurrent urinary infections Renal impairment (from obstructive nephropathy) Bladder stones Q: What tests should you order? (see Chap. 3) A: Urinalysis/urine microscopy and culture, serum creatinine…
The Patient with Fecal Incontinence
, Jenny Rex2 and Patrick Stewart3 (1) Department of Colorectal Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia (2) Stomotherapy Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia (3) University of NSW…
The Older Patient
Reduced Bladder sensation Detrusor contractility Ability to postpone urination Urinary flow rates (Females) estrogen causing atrophy of urothelium and vaginal mucosa Increased Involuntary detrusor contractions Post-void residuals Nocturnal urine production…
Practical Anatomy and Physiology of Urinary Continence
Fig. 2.1 Urinary sphincters in the male and female. BN bladder neck, BU bulbar urethra, EUS external (rhabdo) sphincter, P prostate, PPL puboprostatic ligament, PUL pubourethral ligament, SV seminal vesicle…
The Female Patient
1. Conservative (a) Bladder training 2. Anticholinergics (antimuscarinics) (a) Non-uroselective i. Oxybutynin ii. Propantheline (b) Uroselective i. Solifenacin ii. Darifenacin iii. Fesoterodine iv. Trospium v. Propiverine 3. Surgical (a) Botulinum toxin A (b) S3 sacral neuromodulation…
Introduction
Fig. 1.1 Global prevalence of incontinence (Based on findings from Minassian et al., Urinary Incontinence as a Worldwide Problem (Minassian et al. 2003)) Urinary incontinence increases with age. The prevalence…
