Urogynecology: Evidence-Based Clinical Practice
Urogynecology: Evidence Based Clinical Practice 2nd Edition is a fully revised and updated text providing an evidence based approach to the treatment of urinary incontinence and prolapse. This updated version incorporates new evidence in the areas of
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This chapter deals first with incontinence/voiding dysfunction, then prolapse and fecal incontinence. Detailed history taking for bacterial cystitis and interstitial cystitis is included in the relevant chapters, but the basic features are given here. Many urogynecology patients have multiple symptoms, for example, mixed stress and urge leak along with prolapse or postoperative voiding difficulty with recurrent cystitis and dyspareunia. It is important to untangle or dissect the different problems and then tackle them one by one (although the total picture must fit together at the end). To help you manage the patient, ask, “What is your main problem. What bothers you the most?” Only after you have sorted this question out fully should a systematic review be undertaken. Let the patient tell you her story.
History Taking for Incontinent Women Incontinence Symptoms Stress Incontinence (leakage with cough, sneeze, lifting heavy objects; see Fig. 1.1a). Note that stress incontinence is a symptom. Stress incontinence is a physical sign (see Chap. 2). Urodynamic stress incontinence means that on urodynamic testing the patient leaks with a rise in intra-abdominal pressure, in the absence of a detrusor contraction (see Fig. 1.1b and Chap. 4). K.H. Moore, Urogynecology: Evidence-Based Clinical Practice, DOI 10.1007/978-1-4471-4291-1_1, © Springer-Verlag London 2013
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Chapter 1. Taking the History
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Figure 1.1 (a) Stress incontinence, leakage associated with raised intra-abdominal pressure. (b) Urge incontinence, leakage associated with a detrusor contraction
Urge incontinence (leakage with the desperate desire to void) is a symptom that is difficult to elicit on physical examination (see Chap. 2). On urodynamic testing, if the patient leaks when a detrusor contraction occurs, associated with the symptom of urgency, the condition is termed detrusor overactivity (see Chap. 4). Many patients will have mixed stress and urge incontinence but can tell you which one bothers them the most or makes them leak the most. Take the time to ask the patient, because this guides initial therapy and helps you to interpret urodynamic tests.
Nonincontinent Symptoms of Storage Disorders: Frequency, Urgency, and Nocturia Frequency of micturition is defined as eight or more voids per day.
The Frequency–Volume Chart (FVC)
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The normal adult with an average fluid intake of 1.5–2 l/day will void five to six times per day. If a woman has increased frequency, ask whether she voids “just in case”: before going shopping and so on, because many women with stress incontinence do this to avoid having a full bladder when they lift shopping bags and the like. The difference is important. The woman with an overactive detrusor muscle will rush to the toilet frequently because she has an urgent desire to void, caused by the bladder spasm, and she is afraid she will leak if she does not make the toilet on time. The urgent desire to void for fear of leakage is defined as “urgency.” Nocturia is defined as the regular need to pass urine once or mor
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