Editing Functional: Urinary Incontinence (section)

==== Urodynamics ====
* '''Should only be performed when it is going to change the management of the patient'''
** Consider UDS in patients who are 
***Considering invasive, potentially morbid or irreversible surgery
***Have failed previous pelvic floor reconstruction
***Have mixed incontinence, urinary urgency, or obstructive symptoms
***Patients who have elevated PVRs or neurologic disease.
* Multichannel UDS offers an extensive evaluation of LUT function.
** The degree of accuracy provided by multichannel UDS is important in a variety of circumstances, including:
*** Conservative treatment methods fail
*** Diagnosis is unclear
*** Previous diagnostic procedures are inconclusive
*** Clinical pictures complicated by radiation therapy, neurologic disease, or prior failed pelvic floor reconstruction or antiincontinence surgery
*** Symptoms that cannot be confirmed by the clinician.
* One important scenario that can occur during urodynamics is cough-induced detrusor overactivity incontinence, which happens when the patient coughs and this action initiates an involuntary detrusor contraction, and the patient leaks because of the detrusor overactivity contraction rather than because of the raised intra-adominal pressure generated by the cough. Clinically, it sounds as if the patient is leaking because of SUI, whereas the urodynamics show that he has cough-induced detrusor overactivity.
* '''Occult SUI is SUI unmasked by reduction of prolapse; 11-50% of clinically continent patients will develop de novo SUI after repair of high-grade prolapse.'''
* '''Colpopexy and Urinary Reduction Efforts (CARE) trial'''
** '''Population: women with SUI undergoing sacrocolpopexy for prolapse'''
** '''Randomized to concomitant Burch colposuspension vs. no concomitant procedure'''
** '''Results'''
*** Premature termination of trial after the first interim analysis at 3 months which showed '''significant reduction in SUI in patient undergoing Burch vs. control''' (24% vs. 44%)