Table II-2-2. Cystometric Volume Measurements
| Post-void residual | <50 mL |
| Sensation of fullness | 200–225 mL |
| Urge to void | 400–500 mL |
Classification of Incontinence
Most of the following types of incontinence result when bladder pressure rises in isolation of increases in urethral pressure.
Sensory Irritative Incontinence
• Etiology. Involuntary rises in bladder pressure occur owing to detrusor contractionsstimulated by irritation from any of the following bladder conditions: infection, stone, tumor, or a foreign body.
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Chapter 2 l Pelvic Relaxation
• History. Loss of urine occurs with urgency, frequency, and dysuria. This can take placeday or night.
• Examination. Suprapubic tenderness may be elicited, but otherwise the pelvic exami-nation is unremarkable.
• Investigative studies. A urinalysis will show the following abnormalities: bacteria andwhite blood cells (suggest an infection) or red blood cells (suggest a stone, foreign body, or tumor). A urine culture is positive if an infection is present. Cystometric studies (which are usually unnecessary) would reveal normal residual volume with involuntary detrusor contractions present.
• Management. Infections are treated with antibiotics. Cytoscopy is used to diagnose andremove stones, foreign bodies, and tumors.
Genuine Stress Incontinence. This is the most common form of true urinary incontinence.
• Etiology. Rises in bladder pressure because of intraabdominal pressure increases (e.g.,coughing and sneezing) are not transmitted to the proximal urethra because it is no longer a pelvic structure owing to loss of support from pelvic relaxation.
• History. Loss of urine occurs in small spurts simultaneously with coughing or sneez-ing. It does not take place when the patient is sleeping.
• Examination. Pelvic examination may reveal a cystocele. Neurologic examination isnormal. The Q-tip test is positive when a lubricated cotton-tip applicator is placed in the urethra and the patient increases intraabdominal pressure, the Q-tip will rotate >30 degrees.
• Investigative studies. Urinalysis and culture are normal. Cystometric studies are nor-mal with no involuntary detrusor contractions seen.
• Management. Medical therapy includes Kegel exercises and estrogen replacement inpostmenopausal women. Surgical therapy aims to elevate the urethral sphincter so that it is again an intraabdominal location (urethropexy). This is done by attachment of the sphincter to the symphysis pubis, using the Burch procedure as well as the Marshall-Marchetti-Kranz (MMK) procedure. The success rate of both of these procedures is 85–90%. A minimally invasive surgical procedure is the tension-free vaginal tape pro-cedure in which a mesh tape is placed transcutaneously around and under the mid urethra. It does not elevate the urethra but forms a resistant platform against intraab-dominal pressure.
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GYN Triad
Stress Incontinence
• Involuntary loss of urine
• With coughing and sneezing
• No urine lost at night
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