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Functional: Female SUI
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=== History and Physical Exam=== ==== History ==== *'''<span style="color:#ff0000">Characterize incontinence</span>''' (stress, urgency, mixed, continuous, without sensory awareness) **Presence of coughing, sneezing, lifting, walking, or running as initiators of incontinence increases the likelihood of SUI as the cause of urinary leakage **'''<span style="color:#ff0000">Chronicity of symptoms</span>''' **'''<span style="color:#ff0000">Frequency, bother, and severity</span>''' of incontinence episodes. Pad or protection use. ***'''<span style="color:#ff0000">An assessment of bother is paramount to the decision to operate in the index patient.</span>''' * '''<span style="color:#ff0000">Associated</span>''' **'''<span style="color:#ff0000">Urinary tract symptoms</span>''' (e.g., urgency, frequency, nocturia, dysuria, hematuria, slow flow, hesitancy, incomplete emptying) **'''<span style="color:#ff0000">Pelvic symptoms</span>''' (e.g., pelvic pain, pressure, bulging, dyspareunia) **'''<span style="color:#ff0000">GI symptoms</span>''' (e.g., constipation, diarrhea, splinting to defecate) *'''<span style="color:#ff0000">Menopausal status</span>''' *'''<span style="color:#ff0000">Obstetric history</span>''' (e.g., gravity, parity, method of delivery) *'''<span style="color:#ff0000">Previous pelvic surgeries</span>''' *'''<span style="color:#ff0000">Past medical history</span>''' (e.g., hypertension, diabetes, history of pelvic radiation) *'''<span style="color:#ff0000">Current and past medications</span>''' *'''<span style="color:#ff0000">Fluid, alcohol, and caffeine intake</span>''' *'''<span style="color:#ff0000">Previous treatments for incontinence</span>''' (e.g., behavioral therapy, Kegel exercises/pelvic floor muscle training, pharmacotherapy, surgery) *'''<span style="color:#ff0000">Patient’s expectations of treatment</span>''' (patient-centered goals) * '''<span style="color:#ff0000">History alone, while helpful, does not definitively diagnose SUI in women</span>''' ====Physical exam (6): ==== #'''<span style="color:#ff0000">Stress test (supine and/or standing) with comfortably full bladder</span>''' #'''<span style="color:#ff0000">Focused abdominal examination</span>''' #'''<span style="color:#ff0000">Urethral mobility</span>''' (Q-tip test or other method) # '''<span style="color:#ff0000">Pelvic prolapse</span>''' (any method) #'''<span style="color:#ff0000">Vaginal atrophy/estrogenization status</span>''' #'''<span style="color:#ff0000">Focused neurologic examination</span>''' ====Objective demonstration of SUI==== *'''<span style="color:#ff0000">Stress test (supine and/or standing) with comfortably full bladder</span>''' ** Considered positive if involuntary urine loss from the urethral meatus is witnessed coincident with increased abdominal pressure ***A positive stress test had a high sensitivity and specificity for detecting SUI **'''If leakage is not witnessed in the supine position, the test may be repeated in the standing position to facilitate the diagnosis''' ====Urinalysis==== *Screen for abnormalities (microscopic hematuria, pyuria, etc.), which may prompt further investigations and reveal underlying cause (bladder tumour, for example) of incontinence ====Post-void Residual (PVR)==== *May prompt further investigations and reveal underlying cause (overflow, for example) of incontinence
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