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Sunday, 24 November 2013

Urinary Incontinence - The Diagnosis

Urinary Incontinence, a medical, psychological, social, economic, and hygienic problem, is defined as a condition of loss of the bladder to control that can lead to mild or severe form of involuntary leakage of urine. Involuntary urine leakage or urinary incontinence is frequent among elderly women, adult women, even among adolescent women.
IV. Diagnosis and tests
After completing  family and medical history, including a voiding diary, incontinence questionnaire , directed family member who have past history of the same diseases, bowel habits, patterns of urination and leakage etc., a  physical examination of of the abdomen, rectum, genitals, and pelvis with the the cough stress test, can be helpful to determine the type of urinary incontinence. The tests that your doctor orders may include
1. Urine test
  A sample of your urine is sent to a laboratory, where it's checked for signs of infection, traces of blood or other abnormalities. 
2. Blood test
A sample of your  blood is checked for chemicals and substances related to causes of incontinence.
3. Postvoid residual (PVR) volume test
Postvoid residual (PVR) volume test is the test to the amount of leftover (residual) urine in your bladder after you're asked to urinate. In the study to  estimate the prevalence and clinical and urodynamic associations of postvoid residual volumes (PVRs), measured immediately after micturition, in women with symptoms of pelvic floor dysfunction, found that the overall prevalence of PVRs was 76% at 0-10 mL, 5% at 11-30 mL, 5% at 31-50 mL, 8% at 51-100 mL, and 6% at more than 100 mL. Thus, using transvaginal ultrasonography, 81% of immediate PVRs were 30 mL or less. Higher than 30 mL, a significantly increased prevalence of women presenting with recurrent urinary tract infections (UTIs) was noted (P<.001). The level of 30 mL was deemed to be an appropriate upper limit of normal PVR. The prevalence of PVRs higher than 30 mL increased significantly with age (P<.001) and higher grades of prolapse (P<.001). There was a significant inverse relation of PVRs higher than 30 mL to the symptom of stress incontinence (P=.018) and the diagnosis of urodynamic stress incontinence (P<.001)(19).
4. Pelvic ultrasound.
Pelvic Ultrasound is the test to exam the pelvic region, including the urinary tract or genitals to check for abnormalities. Dr. Dalpiaz O, and Dr. Curti P. at the University of Verona, showed that Ultrasound has become an indispensable diagnostic procedure in urogynecology. Perineal, introital, and endoanal ultrasound are the most recommended techniques and the results comprise qualitative and quantitative findings. These are important for determining the localization of the bladder neck and vesico-urethral junction and also for pre- and postoperative comparisons, and moreover for clinical applications and scientific investigations(20).
5. stress urinary incontinence Q-tip test
Q-tip test is a test with a cotton-tipped stick lubricated with xylocaine gel is placed into the urethra up to, but not through the internal urethral sphincter (Q-tip test). With straining or coughing, the stick rises more than 30 degrees from it's resting angle. This demonstrates urethral hypermobility and differentiates genuine stress incontinence from an intrinsic urethral sphincteric insufficiency (ISD) without hypermobility(21).
6. Urodynamic testing. These tests measure pressure in your bladder when it's at rest and when it's filling. A doctor or nurse inserts a catheter into your urethra and bladder to fill your bladder with water. Meanwhile, a pressure monitor measures and records the pressure within your bladder. This test helps measure your bladder strength and urinary sphincter health, and it's an important tool for distinguishing the type of incontinence you have(22).  
7. Cystogram
A cystography is a procedure that your doctor can visualise the urinary bladder with X-ray of the bladder by the injects a fluid containing a special dye. In the study to compare the urodynamic findings and results of lateral cystourethrography in 82 patients with incontinence, showed that a significantly higher increase of the posterior urethrovesicular angle was noted in patients with a urodynamic stress incontinence than in patients with urge incontinence or those with normal urodynamic findings. Lateral cystourethrography as compared to urodynamic assessment, proved to be a method with high sensitivity (91%) but little specificity. These two methods supply different but complementary data. Together with history, assessment of patients' complaints, clinical vaginal examination, and clinical stress test they offer valuable information for an efficient therapeutic concept(23).
8. etc.
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Sources
(19) http://www.ncbi.nlm.nih.gov/pubmed/18515513
(20) http://www.ncbi.nlm.nih.gov/pubmed/16688711 
(21) http://www.wdxcyber.com/dxurp001.htm
(22) http://www.ncbi.nlm.nih.gov/pubmed/16688711 
(23) http://www.ncbi.nlm.nih.gov/pubmed/2318407