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The history should include
-details of the type
- timing and severity of UI
- associated voiding 
-other urinary symptoms.
The history should allow UI to be categorised into
-stress urinary incontinence (SUI)
-urgency urinary incontinence (UUI)
-mixed urinary incontinence (MUI)
Physical examination should inlude
-abdominal examination, to detect an enlarged bladder or other abdominal mass
- perineal and digital examination of the rectum (prostate) and/or vagina
Examination of perineum in women include
-an assessment of oestrogen status
- a careful assessment of any associated pelvic organ prolapse (POP)
 A cough test may reveal
-SUI if the bladder is sufficiently full and pelvic floor contraction together with urethral mobility can be assessed digitally.
The Laplas equation shows
-direct relationship between wall tension and intravesical pressure and bladder size
The Laplas equation
-T=P* R/2
The human bladder is composed
-50% collagen
-2% elastin
The bladder  compound and injury, obstruction or denervation
-collagen contenets increases
-compliance falls
Bladder compliance
Muscarinic receptors induce
-detrusor contraction in response to acetylcholine released from parasympathetic nerve terminals by calcium entry through Ca2+ channels
Uroplakin proteins may be  a key part of
-the primary plasma-urine barrier
Protamine sulfate
-increases the luminal surface of umbrellas cells permeability to cations and anions
Urinary continence in female
-passive transmission of abdominal pressure to the proximal urethra
-acive contraction of striated muscle of the extermnal sphincter (guardian reflex)
-hammock hypothesis (support of posterior wall)
LUTS are considered as three group symptoms
Storage symptoms
-increase daytime frequencey
-one or more times at night to void
-compliant of sudden, compelling desire to pass urine, which is difficult to defer
Clinical and Urodynamic diagnosis of SI
-loss of urine synchronous with exertion, sneezing, or coughing
-involuntary leakage of urine during increases in abdominal pressure in the absence of a detrusor contraction (urodynamic stress incontinence)
Urgency UI
-symptomaic comlaint of involuntary leakage accompied  by or immediately precede by urgency as contrasted to urge, which is a normal sensation
 Clinical and Urodynamic diagnosis of incontinence related to an
-loss from urethra that is accompanied by or immediately preceded by urgency
-involuntary detrusor contraction during urodynamics (so-called detrusor overactivity associated incontinence)
Mixed UI
-involuntary leakage associated with urgency and also with exertion, effort, sneezing, or coughing
Sign of mixed UI
-loss of urine with exertion, sneezing, or coughing
-and an involuntary urinary loss from the urethra that is accompanied by or immediately preceded by urgency
Urodynamic diagnosis of mixed UI
-both involuntary leakage of urine during increases in abdominal pressure
-present in 40 % of women with SI
OAB or
-the urgency frequency symptom
-comprises urgency
-with or without UI
-usually with frequency and nocturia
Mixed urinary symptoms
-combination of OAB without UI and SI
Continous UI
-is the complaint of continuous leakage
Other types or UI
-postmicturition dribble
-extraurethral incontinence (fistula, ectopic ureter)
Causes of Transient incontinence
-Atrophic vaginitis/urethritis
-Psychologic (severe depression. neurosis)
-Excess or urine production
-Restricted mobility
-Stool impaction
History of present illness
-incontinence should be chaacterized subjectively
-leakage should by quantified if possibel
-the voiding pattern should be defined
-duration of symptoms and inciting events
-impact on the patients daily life and activities
Subjective characteristic of incontinence
-does the leakage occur with
-physiscal activity
-with sence of urgency
-without sensory awarness
-neurologic conditions (PD, MS, CVA,SCI,myelodysplasia, DM, dementia)
-radiation therapy
-gynecologic and obstetric history
-sympathomimetics (increase BOO, exacerbate OAB)
-sympatholytics (decrease BOO)
-anticholiergics (can contribute urinary retention in pts with BOO)
-diuretics (do not affect bladder activity, but increases urine production)
POP-Q Staging criteria
-I need explanaton
BCR (bulbocavernosus reflex)
-representative of sacra nerve root levels S2-S4
-present in 70% of normal females
-and present in 100% of normal males
-HRQOL  (Health Related Quality of Life) questionaires
-Symptom Bother
-POP Symptoms and QOL
ICIQ (International Consultation on Incontinence) questionaires
-ICIQ-SF (short form)
-ICIQ-VS (vaginal symptoms)
-ICIQ-B (bowel)
Pad tests
-did not recommended
Pad test grading
-1,3-20 mild
-21-74 moderate
-more than 75 severe
Normal vaginal secretion
-0,3 in 24 hours
Dye testing
-oral phenazopyridine
-intravesical instillation of methylene blue
Symptom measures and health related QOL measures (EAU) Category A
ICIQ-UI  Short Form
 I-QOL (ICIQ-Uqol)
 ISS, KHQ, LIS (?-interview), N-QoL, OAB-q SF, OAB-q (ICIQOABqol), PFDI and PFDI20, PFIQ and PFIQ-7, PRAFAB, UISS;
Screening tools (used to identify patients with UI)
-B-SAQ (bladder self assessment questionaire)
Voiding diary (EAU)
-measurement of the frequency and severity of LUTS
Terminolgy of voiding diary (EAU)
-micturition time cahrts
-frequency volume charts
-voiding diaries
Micturition charts
 -record only the times of micturitions for a minimum of 24 continuous hours
Frequency Volume Charts
- record voided volumes and times of micturitions for a minimum of 24 hours
Voiding diaries
-include information on incontinence episodes, pad usage, fluid intake, degree of urgency and degree of UI.
Urinalysis negative for nitrite and leucocyte esterase
-has high specificity to exclude UTI in people with UI
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