Üriner İnkontinans ve Ürodinamik Testler
Özet
Üriner inkontinans, objektif olarak gösterilebilen ve sosyal/hijyenik problemlere yol açan istemsiz idrar kaçırma durumudur. Kadınların yaklaşık %50'sini etkileyen bu rahatsızlık; stres, sıkışma (urge), miks, taşma ve fonksiyonel olmak üzere farklı tiplere ayrılır. Tanı aşamasında detaylı anamnez, 3 günlük işeme günlüğü, fizik muayene ve idrar analizi gibi temel değerlendirmeler kullanılır. Ayrıca öksürük-stres testi, ped testi, Q-tip testi ve işeme sonrası rezidü idrar (PVR) ölçümü gibi basit testler uygulanır. Basit tıbbi durumlar için ürodinami gereksizken; tanı konulamayan, cerrahi planlanan, miks semptomları olan veya önceki tedavileri başarısız olmuş komplike vakalarda ürodinamik incelemeler (üroflowmetri, dolum sistometrisi ve basınç-akım çalışmaları) alt üriner sistemin depolama ve boşaltma fonksiyonlarını anlamak için kritik önem taşır.
Urinary incontinence is the involuntary leakage of urine that can be objectively demonstrated and causes social and hygienic problems for the patient. Affecting approximately 50 percent of women, this condition is classified into different types, including stress, urge, mixed, overflow, and functional incontinence. In the diagnosis phase, basic evaluations such as a detailed medical history, a 3-day voiding diary, physical examination, and urinalysis are utilized. Additionally, simple tests like the cough stress test, pad test, Q-tip test, and post-void residual (PVR) urine measurement are performed. While urodynamics is unnecessary for straightforward medical conditions, urodynamic investigations—including uroflowmetry, filling cystometry, and pressure-flow studies—are of critical importance for understanding the storage and emptying functions of the lower urinary tract in complicated cases where the diagnosis remains unclear, surgery is planned, mixed symptoms are present, or previous treatments have failed.
Referanslar
Griffiths, A. N., A. Makam and G. J. Edwards (2006). "Should we actively screen for urinary and anal incontinence in the general gynaecology outpatients setting?--A prospective observational study." J Obstet Gynaecol 26(5): 442-444.
Morrill, M., E. S. Lukacz, J. M. Lawrence, C. W. Nager, R. Contreras and K. M. Luber (2007). "Seeking healthcare for pelvic floor disorders: a population-based study." Am J Obstet Gynecol 197(1): 86.e81-86.
Barry, M. J., C. L. Link, M. F. McNaughton-Collins and J. B. McKinlay (2008). "Overlap of different urological symptom complexes in a racially and ethnically diverse, community-based population of men and women." BJU Int 101(1): 45-51.
Holroyd-Leduc, J. M., C. Tannenbaum, K. E. Thorpe and S. E. Straus (2008). "What type of urinary incontinence does this woman have?" Jama 299(12): 1446-1456.
Abrams, P., K. E. Andersson, L. Birder, L. Brubaker, L. Cardozo, C. Chapple, A. Cottenden, W. Davila, D. de Ridder, R. Dmochowski, M. Drake, C. Dubeau, C. Fry, P. Hanno, J. H. Smith, S. Herschorn, G. Hosker, C. Kelleher, H. Koelbl, S. Khoury, R. Madoff, I. Milsom, K. Moore, D. Newman, V. Nitti, C. Norton, I. Nygaard, C. Payne, A. Smith, D. Staskin, S. Tekgul, J. Thuroff, A. Tubaro, D. Vodusek, A. Wein and J. J. Wyndaele (2010). "Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence." Neurourol Urodyn 29(1): 213-240.
Lim, Y. N. and P. L. Dwyer (2009). "Effectiveness of midurethral slings in intrinsic sphincteric-related stress urinary incontinence." Curr Opin Obstet Gynecol 21(5): 428-433.
Ouslander JG. Management of overactive bladder. N Engl J Med 2004; 350: 786-99
Nygaard, I. (2010). "Clinical practice. Idiopathic urgency urinary incontinence." N Engl J Med 363(12): 1156-1162.
Myers, D. L. (2014). "Female mixed urinary incontinence: a clinical review." Jama 311(19): 2007-2014
Zimmern, P., H. J. Litman, C. W. Nager, G. E. Lemack, H. E. Richter, L. Sirls, S. R. Kraus, G. Sutkin and E. R. Mueller (2014). "Effect of aging on storage and voiding function in women with stress predominant urinary incontinence." J Urol 192(2): 464-468.
Weiss BD. Diagnostic evaluation of urinary incontinence in geriatric patients. Am Fam Physician 1998; 57: 2675-2684, 2688-90
Orgensen L, Lose G, Anders J. One-hour pad weighing test for objective assessment of female incontinence. Obstet Gynecol 1987; 69: 39-43
McKertich K. Urinary incontinence: Assessment in women: Stress, urge or both? Aust Fam Physician 2008; 37: 112-7
Khandelwal C, Kistler C. Diagnosis of urinary incontinence. Am Fam Physician 2013; 87: 543-50
Kobashi, K. C., M. E. Albo, R. R. Dmochowski, D. A. Ginsberg, H. B. Goldman, A. Gomelsky, S. R. Kraus, J. S. Sandhu, T. Shepler, J. R. Treadwell, S. Vasavada and G. E. Lemack (2017). "Surgical Treatment of Female Stress Urinary Incontinence: AUA/SUFU Guideline." J Urol 198(4): 875-883
Jensen, J. K., F. R. Nielsen, Jr. and D. R. Ostergard (1994). "The role of patient history in the diagnosis of urinary incontinence." Obstet Gynecol 83(5 Pt 2): 904-910.
Ward, R. M., B. S. Hampton, J. D. Blume, V. W. Sung, C. R. Rardin and D. L. Myers (2008). "The impact of multichannel urodynamics upon treatment recommendations for female urinary incontinence." Int Urogynecol J Pelvic Floor Dysfunct 19(9): 1235-1241.
Verghese, T. S., L. J. Middleton, J. P. Daniels, J. J. Deeks and P. M. Latthe (2018). "The impact of urodynamics on treatment and outcomes in women with an overactive bladder: a longitudinal prospective follow-up study." Int Urogynecol J 29(4): 513-519.
Huang, L., L. He, S. L. Wu, R. Y. Sun and D. Lu (2016). "Impact of preoperative urodynamic testing for urinary incontinence and pelvic organ prolapse on clinical management in Chinese women." J Obstet Gynaecol Res 42(1): 72-76.
Glazener, C. M. and M. C. Lapitan (2002). "Urodynamic investigations for management of urinary incontinence in adults." Cochrane Database Syst Rev(3): Cd003195.
Lucas MG, Bedretdinova D, Bosch JLHR, et al. Guidelines on Urinary Incontinence. European Association of Urology (EAU). Urinary Incontinence- 2014.
Sorel, M. R., H. J. B. Reitsma, P. Rosier, R. Bosch and L. M. O. de Kort (2017). "Uroflowmetry in healthy women: A systematic review." Neurourol Urodyn 36(4): 953-959.
Haylen, B. T., D. Ashby, J. R. Sutherst, M. I. Frazer and C. R. West (1989). "Maximum and average urine flow rates in normal male and female populations--the Liverpool nomograms." Br J Urol 64(1): 30-38.
Scotti, R. J. and D. L. Myers (1993). "A comparison of the cough stress test and single-channel cystometry with multichannel urodynamic evaluation in genuine stress incontinence." Obstet Gynecol 81(3): 430-433.
Abrams, P., J. G. Blaivas, S. L. Stanton and J. T. Andersen (1988). "The standardisation of terminology of lower urinary tract function. The International Continence Society Committee on Standardisation of Terminology." Scand J Urol Nephrol Suppl 114: 5-19
Nitti, V. W. and S. Raz (1994). "Obstruction following anti-incontinence procedures: diagnosis and treatment with transvaginal urethrolysis." J Urol 152(1): 93-98.
