Download SUI: history and PE

In the name of God
UI: evaluation
Dr. reza aghelnezhad
Urologist, endourology fellowship
KUMS
DIAPPERS:
causes of transient incontinenc
History:
History of Present Illness 1
• The incontinence should first be
characterized subjectively. Does the
leakage occur (1) with physical activity?
(2) with a sense of urgency? or (3) without
sensory awareness? If the nature of the
incontinence is mixed, does one
component cause more bother or occur
more frequently than the other?
History of Present Illness 2
• Second, the leakage should be quantified if
possible. Appraisal of the degree of leakage before
therapy can be helpful during postoperative
assessment of treatment impact. For the purposes
of routine outpatient assessment, this quantification
can be achieved on the basis of the number of pads
used per day or the frequency of clothing changes
due to urinary leakage. In the setting of research or
an academic practice, more stringent and objective
measures such as pad weight testing are often
used.
History of Present Illness 3
• Third, the voiding pattern should be
defined. What is the frequency of
urination during the day? During the night?
Are there any obstructive symptoms?
Does the patient feel as though he or she
empties the bladder completely? Is the
stream strong? Does the stream fluctuate
during the void? Is it necessary to strain to
empty the bladder?
History of Present Illness 4
• Fourth, establishment of the duration of
symptoms and any inciting events that
contributed to the onset of leakage is
important. Did the leakage follow a
pregnancy or a vaginal delivery or start
after a fall, or trauma or pelvic or back
surgery? has there been any prostate or
urethral surgery? Are there any neurologic
symptoms such as numbness or tremor?
History of Present Illness 5
• Finally, it is helpful to determine the
impact that the leakage has on the
patient’s daily life and activities. Does
the incontinence limit the individual’s
activity? Has the patient changed his or
her lifestyle due to the threat of leakage?
Past medical and surgical
histories
•
•
•
•
•
Neurologic conditions: Parkinson, stroke
Medical diagnoses: COPD, DM
radiation therapy
trauma
gynecologic and obstetric history:
gravity, parity, and hormonal status
• previous pelvic surgery
• smoking
Medications
•
•
•
•
Sympathomimetics
Sympatholytics
Anticholinergics
Diuretics
PHYSICAL EXAMINATION
•
•
•
•
•
•
•
General appearance
Estrogen status
Urethral position and mobility
Assessment of prolapse
Neurologic examination
Bulbocavernosus reflex
Digital rectal examination
POP-Q staging
POP-Q criteria
evaluation
•
•
•
•
•
•
•
•
Urinalysis
PVR measurement
Voiding diaries
Questionnaires& quality of life instruments
Pad tests
Dye tests
Cystoscopy
Urodynamics
Radiographic imaging
• Voiding cystourethrogram
• Ultrasound
• Magnetic resonance imaging