Clinical Case Database / Category: Patient Management
Stress Urinary Incontinence
Publication details
Dr Jennifer Davies, Dr Sara Farrell
Foundation Years Journal, volume 8, issue 9, p.80 (123Doc Education, London, October 2014)
Abstract
Urinary incontinence is a common condition affecting up to 50% of women of any age in the UK. It has major psychosocial implications for the woman's life as well as financial implications for the health service. In this article through diagrams and case scenarios we have explored the mechanism behind urinary stress incontinence and approaches to its diagnosis and management. Accurate diagnosis of the type of urinary incontinence is essential to choosing the correct management. Urodynamic studies provide a useful adjunct to a detailed history, examination and urine analysis.
Management options for urinary stress incontinence include conservative measures such as weight loss and supervised pelvic floor muscle exercises, medical treatment with Duloxetine and surgical treatments including suburethral slings and colposuspension. Patients who are not candidates for surgery can be offered intramural urethral bulking injections. Two case scenarios illustrate factors involved in diagnosis and choice of treatment. The future for urinary stress incontinence may lie in using autologous stem cells from the patient's own skeletal muscle as urethral bulking agents.
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Authors
Dr Jennifer Davies
Consultant in Obstetrics and Gynaecology
Royal Albert Edward Infirmary
Wigan Lane, Wigan, WN1 2NN
jennifer.davies@wwl.nhs.uk
Dr Sara Farrell
ST2 in Obstetrics and Gynaecology
Department of Obstetrics & Gynaecology
Royal Albert Edward Infirmary
Wigan Lane, Wigan, WN1 2NN
sara.farrell@wwl.nhs.uk
References
1. National Institute for Health and Clinical Excellence. Urinary incontinence: the management of urinary incontinence in women. NICE Clinical Guideline 171. London: NICE; 20013.
2. StratOG.net. Management of lower urinary tract dysfunction. London: StratOG, 2012. www. rcog. org.uk/stratog
3. Sinclair AJ, Ramsay IN. The psychosocial impact of urinary incontinence in women. The Obstetrician & Gynaecologist.2011; 13:143â€"148.
4. Moore K.L. et al., Clinically Oriented Anatomy, 2010, 5th edition, Baltimore, Wolters Kluwer/ Lippincott Williams & Wilkins, 332-334
5. Karl M Luber. The definition, prevalence, and risk factors for stress urinary incontinence. Rev Urol. 2004 ; 6 (suppl 3): S3-S9.
6. Nikolavasky D, Stangel-Wójcikiewicz K, Stec M, Chancellor MB. Stem cell therapy: a future treatment of stress urinary incontinence. Seminars in Reproductive Medicine. 2011 Jan; 29(1):61-70.
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About the Clinical Cases Database
The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
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