China
Africa
Explore chapters and articles related to this topic
Gynaecology: Questions
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
A 45-year-old woman with a body mass index (BMI) of 35 kg/m2 presents to the gynaecology clinic with symptoms suggestive of stress urinary incontinence (SUI). She has had no treatment from her general practitioner. What information would help you to make a diagnosis of ‘pure’ stress incontinence? (12 marks)Assuming a diagnosis of ‘pure’ stress incontinence in this case, what would be your immediate management plan (non-surgical)? Explain why and how and over what timescale it would be given. (8 marks)
Answers
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Urinary incontinence can be a distressing symptom. It is more commonly seen in women who have had children and can affect their Uves adversely. It is important to define the type of incontinence, as treatment varies widely between that of urge or stress incontinence. Some forms of constant incontinence may be due to congenital abnormalities or neurological deficits. Urodynamic assessment can be used to assess different types of incontinence. Stress incontinence can be managed with pelvic floor exercises and such lifestyle changes as smoking cessation and weight loss, or surgical methods such as transvaginal tape insertion. TVT insertion may require reversal due to unacceptable urinary retention symptoms. Management of urge incontinence also focuses on such lifestyle changes as avoiding caffeine and alcohol, and bladder retraining. Other treatment for urge incontinence involves such medications as antimuscarinic or tricyclic antidepressants.
Fluid balance and continence care
Published in Barbara Smith, Linda Field, Nursing Care, 2019
Stress incontinence (Table 6.5) is caused by a weak urethral sphincter mechanism. (Note that in this case the word ‘stress’ is not related to the everyday meaning of the word, such as ‘I feel stressed’.) Stress incontinence results in urine leakage, usually occurring simultaneously with a rise in abdominal pressure such as during exercise, sneezing or coughing (Yates, 2018a). Contributing factors include childbirth, menopause, obesity, chronic cough and constipation. Stress incontinence mainly affects females, but it can occur in males after prostatectomy.
Understanding and managing autonomic dysfunction in persons with multiple sclerosis
Published in Expert Review of Neurotherapeutics, 2021
Ivan Adamec, Magdalena Krbot Skorić, Mario Habek
Urinary symptoms can manifest either as storage phase dysfunction with incontinence or voiding phase dysfunction with retention and incomplete bladder emptying [52]. These symptoms are one of the most frequent in MS and occur during the course of the disease in up to 97% of pwMS [53]. Incontinence not only has a significant impact on quality of life but can also cause a substantial economic burden due to the cost of medications, incontinence products, and hospital stays [54]. Demyelinating lesions in the spinal cord that interrupt neural connections from the pontine micturition center to the parasympathetic sacral micturition center are thought to cause bladder dysfunction in pwMS [55]. These CNS lesions in turn can lead to detrusor hyperactivity, the most common urinary dysfunction in pwMS [56]. Urodynamic studies have demonstrated that detrusor hyperreflexia is the most common abnormality present, followed by detrusor sphincter dyssynergia and detrusor hyporeflexia [57]. The most common urinary symptom reported in the same study was urinary urgency followed by frequency, urge incontinence, stress incontinence, and dysuria [57].
Perioperative, postoperative and anatomical outcomes of robotic sacrocolpopexy
Published in Journal of Obstetrics and Gynaecology, 2021
Gokhan Sami Kilic, Toy Lee, Kelsey Lewis, Cem Demirkiran, Furkan Dursun, Bekir Serdar Unlu
Thirty-three patients (22.9%) underwent hysterectomy and SCP; 27 patients (18.8%) underwent Burch colposuspension and SCP; 59 patients (41%) had midurethral sling surgeries (TVT and TOT performed in 42 and 17 patients, respectively) and SCP; 25 patients underwent SCP alone (Table 2). All patients complaining of stress urinary incontinence were offered concomitant incontinence surgery with SCP. The group with no urinary incontinence problem underwent multichannel urodynamic testing after discussing the occult urinary incontinence risk (Brubaker et al. 2003). Among this group, urodynamic test proven stress incontinence patients were also offered incontinence surgery. No patients were converted to open surgery. The mean estimated blood loss was 80.9 mL. The mean intra operative blood loss for RSCP was 50.4 mL when concomitant cases were excluded. The median postoperative hospital stay was one day (range: 4 hours to 5 days).
Features of Marfan syndrome not listed in the Ghent nosology – the dark side of the disease
Published in Expert Review of Cardiovascular Therapy, 2019
Yskert von Kodolitsch, Anthony Demolder, Evaldas Girdauskas, Harald Kaemmerer, Katharina Kornhuber, Laura Muino Mosquera, Shaine Morris, Enid Neptune, Reed Pyeritz, Svend Rand-Hendriksen, Alexander Rahman, Nina Riise, Leema Robert, Ingmar Staufenbiel, Katalin Szöcs, Thy Thy Vanem, Stephan J. Linke, Marina Vogler, Anji Yetman, Julie De Backer
It has been assumed that connective tissue abnormality can contribute to urinary incontinence [247,248], and a high prevalence of urinary incontinence has been reported in women with Marfan syndrome [247–249]. However, urinary incontinence is common in women in general and the estimated prevalence varies depending on several factors, among them the population studied. In adult women in the general population, an estimated prevalence of nearly 50% has been reported, but few patients seek help for the condition [250–252]. Lower prevalence of 10-17% has been reported in non-pregnant women age 20 years and above [253,254]. In a study by Jabs, a significantly higher prevalence was found in female Marfan syndrome patients compared to the general population [255]. Eighty-eight patients reported a history of urinary incontinence and 72% had experienced episodes of stress incontinence. Of these, 52% considered the problems as significant. In this Marfan syndrome population, stress incontinence was not associated with parity. In a study by Chan et al. patients with Marfan syndrome had significantly higher incidence of urinary symptoms, stress incontinence and urge incontinence compared to controls, despite lower parity in the Marfan group [247]. None of the studies have found correlations between joint hypermobility and stress incontinence.