Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-23T00:00:19.302Z Has data issue: false hasContentIssue false

Chapter 27 - Urinary Incontinence

from Section 5 - Post-Reproductive Care

Published online by Cambridge University Press:  24 November 2021

By
Martino Maria Zacche  and
Ilias Giarenis
Edited by
Tahir Mahmood ,
Charles Savona-Ventura ,
Ioannis Messinis  and
Sambit Mukhopadhyay
Tahir Mahmood
Affiliation:
Victoria Hospital, Kirkcaldy
Charles Savona-Ventura
Affiliation:
University of Malta, Malta
Ioannis Messinis
Affiliation:
University of Thessaly, Greece
Sambit Mukhopadhyay
Affiliation:
Norfolk & Norwich University Hospital, UK
Get access

Summary

Urinary incontinence is a common condition in women. All cases require a basic assessment, while urodynamic studies are indicated in those with complex or refractory symptoms. Initial treatment includes lifestyle advice, behavioural modifications, bladder retraining and pelvic floor muscle training. Synthetic mid-urethral sling procedures have revolutionized stress incontinence surgery and reduced the popularity of ‘traditional’ procedures, such as colposuspensions and pubovaginal slings. With regard to urgency urinary incontinence, antimuscarinic agents are the mainstay of current medical management, while a selective β3-adrenergic receptor agonist (Mirabegron) offers an alternative pharmacological option. Intravesical botulinum toxin and neuromodulation (peripheral or sacral) are available to women with refractory symptoms

Keywords

urinary incontinenceurge incontinencestress incontinenceurodynamicsconservative treatmentmid-urethral tapemeshslingscolposuspensionanticholinergicsbeta3 receptor agonistbotulinum toxin
Type
Chapter
Information
The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology
Gynaecology
 , pp. 218 - 226
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Haylen, BT, de Ridder, D, Freeman, RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 2010;29:4–20.Google Scholar
Coyne, KS, Sexton, CC, Thompson, CL, et al. The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden: results from the Epidemiology of LUTS (EpiLUTS) study. BJU Int 2009;104:352–360.CrossRefGoogle ScholarPubMed
Ebbesen, MH, Hunskaar, S, Rortveit, G, Hannestad, YS. Prevalence, incidence and remission of urinary incontinence in women: longitudinal data from the Norwegian HUNT study (EPINCONT). BMC Urol 2013;13:27.Google Scholar
Giarenis, I, Mastoroudes, H, Srikrishna, S, Robinson, D, Cardozo, L. Is there a difference between women with or without detrusor overactivity complaining of symptoms of overactive bladder? BJU Int 2013;112:501–507.Google Scholar
Roosen, A, Chapple, CR, Dmochowski, RR, et al. A refocus on the bladder as the originator of storage lower urinary tract symptoms: a systematic review of the latest literature. Eur Urol 2009;56:810–819.Google Scholar
DeLancey, JO. Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obstet Gynecol 1994;170:1713–1720.Google Scholar
Petros, PE, Ulmsten, UI. An integral theory of female urinary incontinence. experimental and clinical considerations. Acta Obstet Gynecol Scand Suppl 1990;153:7–31.Google Scholar
Kelleher, CJ, Cardozo, LD, Khullar, V, Salvatore, S. A new questionnaire to assess the quality of life of urinary incontinent women. Br J Obstet Gynaecol 1997;104:1374–1379.CrossRefGoogle ScholarPubMed
Avery, K, Donovan, J, Peters, TJ, et al. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn 2004;23:322–330.CrossRefGoogle ScholarPubMed
Wyman, JF, Harkins, SW, Choi, SC, Taylor, JR, Fantl, JA. Psychosocial impact of urinary incontinence in women. Obstet Gynecol 1987; 70:378–381.Google Scholar
Coyne, K, Revicki, D, Hunt, T, et al. Psychometric validation of an overactive bladder symptom and health-related quality of life questionnaire: the OAB-q. Qual Life Res 2002;11:563–574.Google Scholar
Subak, LL, Wing, R, West, DS, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med 2009;360:481–490.Google Scholar
Cody, JD, Jacobs, ML, Richardson, K, Moehrer, B, Hextall, A. Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Database Syst Rev 2012;10:CD001405.Google Scholar
Dumoulin, C, Cacciari, LP, Hay-Smith, EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev 2018;10:CD005654.Google ScholarPubMed
Mariappan, P, Alhasso, A, Ballantyne, Z, Grant, A, N’Dow, J. Duloxetine, a serotonin and noradrenaline reuptake inhibitor (SNRI) for the treatment of stress urinary incontinence: a systematic review. Eur Urol 2007;51:67–74.CrossRefGoogle ScholarPubMed
Vella, M, Duckett, J, Basu, M. Duloxetine 1 year on: the long-term outcome of a cohort of women prescribed duloxetine. Int Urogynecol J Pelvic Floor Dysfunct 2008;19:961–964.Google Scholar
Lapitan, MCM, Cody, JD, Mashayekhi, A. Open retropubic colposuspension for urinary incontinence in women. Cochrane Database Syst Rev 2017;7:CD002912.Google Scholar
Dean, N, Ellis, G, Herbison, GP, Wilson, D, Mashayekhi, A. Laparoscopic colposuspension for urinary incontinence in women. Cochrane Database Syst Rev 2017;7:CD002239.Google Scholar
Albo, ME, Richter, HE, Brubaker, L, et al. Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med 2007;356:2143–2155.Google Scholar
Ulmsten, U, Henriksson, L, Johnson, P, Varhos, G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 1996;7:81–85.CrossRefGoogle ScholarPubMed
Ward, KL, Hilton, P, UK and Ireland TVT Trial Group. Tension-free vaginal tape versus colposuspension for primary urodynamic stress incontinence: 5-year follow up. BJOG 2008;115:226–233.Google Scholar
Delorme, E. Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol 2001;11:1306–1313.Google ScholarPubMed
Richter, HE, Albo, ME, Zyczynski, HM, et al. Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med 2010;362:2066–2076.Google Scholar
Abdel-Fattah, M, Ford, JA, Lim, CP, Madhuvrata, P. Single-incision mini-slings versus standard midurethral slings in surgical management of female stress urinary incontinence: a meta-analysis of effectiveness and complications. Eur Urol 2011;60:468–480.Google Scholar
Zacche, MM, Mukhopadhyay, S, Giarenis, I. Trends in prolapse surgery in England. Int Urogynecol J 2018;29:1689–1695.Google Scholar
Kirchin, V, Page, T, Keegan, PE, et al. Urethral injection therapy for urinary incontinence in women. Cochrane Database Syst Rev 2012;2:CD003881.Google Scholar
Wallace, SA, Roe, B, Williams, K, Palmer, M. Bladder training for urinary incontinence in adults. Cochrane Database Syst Rev 2004;1:CD001308.Google Scholar
Chapple, CR, Khullar, V, Gabriel, Z, et al. The effects of antimuscarinic treatments in overactive bladder: an update of a systematic review and meta-analysis. Eur Urol 2008;54:543–562.Google Scholar
Rai, BP, Cody, JD, Alhasso, A, Stewart, L. Anticholinergic drugs versus non-drug active therapies for non-neurogenic overactive bladder syndrome in adults. Cochrane Database Syst Rev 2012;12:CD003193.Google ScholarPubMed
Abrams, P, Kelleher, C, Staskin, D, et al. Combination treatment with mirabegron and solifenacin in patients with overactive bladder: efficacy and safety results from a randomised, double-blind, dose-ranging, phase 2 study (Symphony). Eur Urol 2015;67:577–588.Google Scholar
Chapple, C, Sievert, KD, MacDiarmid, S, et al. OnabotulinumtoxinA 100 U significantly improves all idiopathic overactive bladder symptoms and quality of life in patients with overactive bladder and urinary incontinence: a randomised, double-blind, placebo-controlled trial. Eur Urol 2013;64:249–256.Google Scholar
Monga, AK, Tracey, MR, Subbaroyan, J. A systematic review of clinical studies of electrical stimulation for treatment of lower urinary tract dysfunction. Int Urogynecol J 2012;23:993–1005.CrossRefGoogle ScholarPubMed
Burton, C, Sajja, A, Latthe, PM. Effectiveness of percutaneous posterior tibial nerve stimulation for overactive bladder: a systematic review and meta-analysis. Neurourol Urodyn 2012;31:1206–1216.CrossRefGoogle ScholarPubMed
Gurocak, S, De Gier, RP, Feitz, W. Bladder augmentation without integration of intact bowel segments: critical review and future perspectives. J Urol 2007;177:839–844.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×