Clinical presentation and diagnosis

The clinical presentation of UI depends on the underlying pathophysiology. The literature evaluating the prevalences of different UI types by age and sex has produced widely varying results due to a number of factors. The clinician should thus consider a given patient as having virtually any type of UI until ruled out during diagnostic evaluation.

A complete medical history and targeted physical examination are essential to correctly classify the type(s) of UI present. It is important to assess the degree of annoyance of the patient due to UI signs and symptoms. The degree of annoyance of the patient may not correlate well with the results of quantitative tests such as symptom frequency/severity, use of absorbent products, frequency/severity of neurologic signs, and postvoid residual urine volume. This is especially the case in "hypersensitive" and "stoic" individuals. Items to address during the evaluation are illustrated in Table 53-2. Components of the physical examination include4:

Table 53-2 Items Which Should Be Addressed During Diagnostic Evaluation of UI

item

Urine leattage

Uwuidt™benl product

OtantiLy losl pen episode

Pik (planus Tiinti of d Jy

Urgwey

Frequency

NtHTuria

OtrelruLlrve sympflans Lcv-nrr jSyJainnu1 fuliryp«

VeiAxj. LypeM duanMLy, limes of dliy worn

■Qvenfity m^iy rplírenvue iíjiwí-ííyhI preference and hyql«** ilwn ilj LJI rype and «.vtiiiy íi'.y. uic lsí liiniL' nivritxT ol [.ulIs bv ■! 1ih(kliotJbly hy^iki-niL pjrkriil with low wüumeloiá

Drlbfciluig verms small volumes ¡nlermil HerHly versus Urge volumes Ccfttfcttnl (X v.irind [jiLinriiM-L

IfeVna ph/5krfllacTlvliy, enresslve fluid mlakp, rimtjtO &iytimt/nigfmirTnVbo1li res/no. henftpiv fu« w.vtc-. duration from urge onset to mltl-umori ■ypiMaddylirnMiighHime/bolh. fxjw cfrefi Vf^Jrv). hiwv ofim. prepon/in íííOClüHf wiih UI

VGi/nc, LyjjoW fltesHanty strain [o void, dctnujsod forte of sluram, slarr and step iire.H", Wiist oi líKOdiíiieie empty**)), s^eiiiy lti/na henN often, hen* js.etc

Comorbidities £u*r£ni meOimi&i u4C Evidence of preej(ls1ing of new-onset:

iSibewi inciitus

Melatlatic o< gftiitourtrary malignancy Multiple KlewK or other neunslogk:di5e«e CNidiiWit above Lhe pots Spinal cord irfwy RiXfnt ncaifjifiiicaiiruryiufqcry Previous local Hjigery/iadialion

Gynecologic hlsloiy Pelvic floor disease un

Gro« himiiuiie sw rjwtS3- i. fiwiitmbtf CAM*, OK*

Dsualy uui

Uui or QUI, depending on level and (tegfee of comptatwKis of injury FuntWonji LJI

ftostalo siiigery, lower abdominal cavity surgery (direct injury versus denervation), irfLi(lon<dlr«( injmy] Childbirth {vaginal vetsuscesarean section), prior gynecologic surgery, hcxirronal status

(pri-vtrvsts peri- pi» rmfflepflirtd) Constipation, dtairhea, fecal »»continence, dyspa neunla, septal dysfunction, pelvic pain

Dysurta. CVA te*>d<M ncss, frequency RSiiibte tiJddirOi Mher [JCfiitOurirLjiy CJfKfr

(ompfemerBry ,jr«i jiw<fi3riw? rnedicaiiofiii tVA, c csravei reftiai angle; ovei-theiouftie*; OUi. c«eff low uiiiwiy incontinence; JH sirev. urlnaty Incomminff; UU urinary Tta<;1 Infection; WL urtje iinnary incontinence

• Abdominal examination (look for distended bladder, organomegaly and masses).

• Neurologic evaluation of perineum and lower extremities to evaluate lumbosacral nerve function (includes digital rectal exam to check rectal tone, reflexes, ability to perform a voluntary pelvic muscle contraction in females and size and surface quality of prostate in males)

• Pelvic exam (females) (look for evidence of prolapse of bladder, small bowel, rectum, or uterus, or estrogen deficiency)

• Genital/prostate exam (men)

• Direct observation of urethral meatus (opening) when patient coughs/strains (urine spurt consistent with SUI)

• Perineal exam (looking for skin maceration, redness, breakdown, ulceration and evidence of fungal skin infection)

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