Urinary incontinence


Definition: Urinary incontinence is an involuntary loss of urine that creates a psychological discomfort, embarrassment and shame to the person worse his lifestyle
Type of incontinence
1. Stress urinary incontinence: loss of urine occurs during physical exertion (sneezing, coughing) that increases abdominal pressure. While in man is due to deficiency of closure (following radical surgery on the prostate, in the case of injury to nerves or mechanisms urethral sphincter), in woman may be due to sphincter deficiency, a dislocation of the bladder neck or to both causes.
2. Urgency urinary incontinence: loss of urine associated with a strong and sudden urge to urinate. May be due to detrusor overactivity or bladder hypersensitivity, or inflammatory conditions.
3. Mixed urinary incontinence: can manifest for both effort and for both urgency

Diagnosis: The patient's medical history and careful physical examination are the first uro-gynecological instruments that allow the formulation of a preliminary diagnosis. May be required complementary investigations base. According to the guidelines of the European Association of Urology for all diagnostic techniques three questions need to be answered: 1) what is the technical accuracy of the test in terms of reproducibility and reliability? 2) What is its diagnostic accuracy compared to a standard? 3) What is its prognostic value?
a. Examination of urine urinary tract infection
b. Ultrasonography (US) measurement of the thickness of the bladder wall (this technique is based on the fact that emptying in opposition to a strong resistance leads to a bladder hypertrophy as occurs in overactive bladder or detrusor hyperactivity), an US provides an accurate estimate of postvoiding residual (PVR)
c. Urodynamic test aims to reproduce the symptoms that are the basis of the disorder reported by the patient. Allows the evaluation of the functionality of the detrusor muscle and measuring the pressure within the bladder. Allows you to collect information about the volumetric capacity of the bladder, for its stability and sensitivity and its adaptive capacity increase of the volume of liquid, it is compliance: it is an interactive process between doctor and patient and therefore is not tolerable execution by a technician and the reading by a clinician.
Treatment
1. Pharmacological: some drugs (oxybutynin, tolterodine, solifenacin, fesoterodine) are generally prescribed for their ability to reduce the contractility of the bladder. Hormone therapy and estrogen replacement may be recommended for women who have reached menopause to increase the muscle tone of the cervico-urethral area
2. Surgical: the assumption that incontinence is linked to a loss of support to the urethra and its downward displacement, the goal of surgery is to stabilize the urethra and increase it, so that to re-establish its normal anatomical relationships with the bladder neck. Surgical treatment makes use of many therapeutic solutions: retro-pubic colposuspension (there are various techniques, some of which have not proved long-lasting). The last decade had become increasingly asserting techniques based on the positioning of sling, or synthetic fabric mesh of under the urethra, supporting more in its middle portion near the bladder. There are two different approaches: (TVT Trans Vaginal Tape) which involves placing the two ends of the mesh on connective tissues retropubic, the TOT (Trans Vaginal Tape Obturator) and the TVT-O, two techniques are very similar that prefer the passage of the mesh through the obturator foramen; both have proved very effective in the short term but lack of corroborating data, especially the TOT, these long term results.
The artificial sphincter works by providing an external pressure through the implantation of a ring, filled with liquid around the urethra. Filling and emptying the ring opens and closes the urethra. To achieve this, it is placed subcutaneously a control device of the ring. During urination, the device is activated manually in order to reduce the pressure around the urethra through the emptying of the liquid, and then the urethra opens. This technique is reserved in selected cases.
3. Rehabilitation: is carried out by different methods (biofeedback, functional electrical stimulation, rehabilitation urine etc ...). These techniques and drug therapies are used in various combinations among them, but the data available in literature are inconclusive for a number of reasons: not homogeneous duration of the studies, the methods of diagnosis and inclusion in studies not homogeneous etc. .. Therefore, some caution is appropriate in asserting the superiority of one method or combination of another.
4. In January 2013, the botulinum toxin has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of overactive bladder in adults who do not respond to conventional anthicolinergic drugs
Congress
27th Annual EAU Congress, Paris 2012. Overactive bladder: NEW SOLUTIONS FOR AN OLD CHALLENGE.
Supplements
European Urology Supplements, Volume 10, Issue 1 March 2011 ISSN1569-9056
Fesoterodine: Individualised CARE IN URGENCY URINARY INCONTINENCE

Abstract
EAU GUIDELINES ON ASSESSMENT AND NON SURGICAL MANAGEMENT OF URINARY INCONTINENCE. European Urology 62 (2012) 1130-1142 
EAU GUIDELINES ON SURGICAL TREATMENT OF URINARY INCONTINENCE. European Urology 62 (2012) 1118-1129 

PHARMASTAR: FDA approves botulinum toxin incontinence resistant to anticholinergic (21 January 2013)