WHAT DOES URINARY INCONTINENCE MEAN? WHICH TYPES DOES IT INCLUDE?

Urinary incontinence can be defined as involuntary urine pass.

Incontinences may be classified in many forms, however the most practical classification for ease of differentiation is as follows:

TRUE STRESS INCONTINENCE (TSI)

Urge incontinence

Neuropathic incontinence

Congenital incontinence

Paradoxical or overflow incontinence

Post traumatic or iatrogenic incontinence

Fistulous incontinence

THE MOST COMMON FORMS OF INCONTINENCES ARE TSI, URGE INCONTINENCE AND MIXED TYPE WHICH INCLUDES THE TWO CONDITIONS.

WHAT IS THE DEFINITION OF STRESS INCONTINENCE? IN WHOM IS IT DETECTED MOST? WHAT ARE THE SYMPTOMS?

Many theories have been suggested for physiopathology of TSI.

The most accepted hypothesis is as follows: None devolvement of the pressure that should devolve into the urethra during stress (straining etc.) because of position fault of the urethra.

It is generally seen in women who had many and difficult deliveries and/or are elder or has lost and gained excess weight. As a result of damage of hip muscles or nerves during the delivery, the neck of the urinary bladder replaces or can not close during coughing, sneezing, laughing, climbing a ladder, carrying a load, sexual intercourse and the patient passes urine.

WHAT IS THE DEFINITION FOR URGENCY INCONTINENCE? HOW DOES IT OCCUR?

Urgency incontinence: It may be defined as having a sudden urination sense and inability to suppress this sense and passing a little urine until urinating.

Over stimulation of bladder nerves is in question. Generally, it is together with urinary tract infection.

WHAT IS THE DEFINITION FOR OVERFLOW INCONTINENCE? IN WHICH CONDITIONS IT IS OBSERVED?

Overflow incontinence defines presence of a continuous residual urine basically. It is not a true incontinence. Obstruction and neurogenic problems are seen as well. An overflow type incontinence occurs.

WHAT ARE TREATMENT OPTIONS FOR STRESS INCONTINENCE?

1. Medical and non-surgical therapies

2. Surgical therapies

The accepted opinion for today is that:

Non surgical treatments may be used for patients who can not handle an operation and have mild complaints.

WHAT ARE NON-SURGICAL TREATMENTS FOR STRESS INCONTINENCE?

NON-SURGICAL TREATMENTS

If the patient is fat, weight loss

Using estrogen preparations orally or vaginally (especially mucosa loosing closing function due to hypoestrogenism in the menopause)

Alpha-adrenergic agents

Tricyclic antidepressants (imipramine) and antimuscarinic drugs (oxybutynin chloride)

Physiotherapy (Keegle’s exercises)

Electrical stimulation, incontinence chairs, biofeedback

Vaginal cones and pezzer catheters

Placement of urethral catheter.

WHAT ARE TARGETS FOR STRESS INCONTINENCE?

The basic purpose for anatomic SI treatment is: TO CORRECT THE URETHRA ANGLE DEFORMED AND TO CORRECT TRANSMISSION OF INTRAABDOMINAL PRESSURE ACCORDINGLY.

The main purpose for intrinsic failure is:

To increase urethral resistance and to provide coaptation.

WHAT ARE SURGICAL TREATMENTS FOR STRESS INCONTINENCE?

There are hundreds of operation techniques in incontinence surgery from open operations to closed techniques; from abdominal operations to intravaginal ones; from operations performed without any cut to laparoscopic techniques performed from several holes on the body.

Retropubic transabdominal procedures (open techniques applied from the abdomen)

(MMK 1949, Burch 1961, Richardson 1981)

Transvaginal Techniques

– Kelly placation 1912

– Needle hanger methods

Pereyra 1959, modified pereyra methods: stamey 1973, raz 1981, gittes 1987, modifiye gittes yahya 1989, leach 1991)

Sling methods

Pubovaginal sling (rectus fascia or fascia lata pr pyramidal muscle etc. have been used)

Anteriovaginal wall sling (Raz)

Sling with synthetic materials (polyglycolic acid – Teflon etc.)

TVT operation

Laparoscopic methods

Burch and slings

Periurethral injections (Teflon- collagen- silicone- glass- oil)

Artificial Urehtral Sphincter (AUS (AMS 800))

WHAT IS URETHRAL CARUNCLE, WHAT ARE THE SYMPTOMS AND HOW IS IT TREATED?

The pathology occurred here is loosening of the mucosa, the inner layer of the urethra and prolapsing outward. While it does not cause any complaint in early stages, it causes partial narrowing on the urinary tract exit when it progresses and grows and may cause bleeding during and/or after the urination and burning sense while urinating (dysuria). This mucosa part prolapsed is removed and remaining mucosa is anastomosed with a simple procedure which may even be performed under office conditions under local or spinal anesthesia. It is a daily surgical intervention.