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Urinary Incontinence is a common condition observed in women of all ages.The loss of urine through other ways not being urethral, is considered as extra-urethral incontinence (example, vesico-vaginal fistula, urethro-vaginal fistula) which will not be discussed in this section.
Urinary incontinence may be resulting from urethral alterations, vesical or mixed. Urethral causes are urethral hypermobility and intrinsic sphincter deficiency (ISD) which compose the stress urinary incontinence (SUI). Among the vesical causes we find: detrusor instability, hyperreflexy of the detrusor, incontinence by overflowing and paradoxical incontinence.The ISD may be caused by multiple surgeries to correct SUI leading to rigidity of the urethra due to fibrosis or decrease of the number of muscle fibers of the urethra due to age. Studies show that the elderly woman has approximately 10% of the number of muscle fibers in comparison to a young woman.
The urodynamic evaluation must be preceded to the anamneses, physical exam, stress test and if possible bladder diary. In the anamneses it is necessary to know the symptoms that precede or accompany urine loss: during laughter, sleep, coughing, exercises or associated to urgency. They must be valued to how long ago the symptoms began and their impact over life quality. The previous history of surgery must be researched as well as the use of medicine and associated illnesses1.
In the physical exam and the vaginal trophism and pelvic dystopias must be verified and dismiss associated illnesses like urethral diverticulum and urethral deformities. The neurological exams that interest us are bulbocavernosus reflex, anal tonus evaluation and perineal sensitivity.
A urine exam and culture must be done before any treatment for urinary incontinence.
The SUI for ISD may be suspected when urine loss is great, elderly patients, multiple operations for the correction of SUI and fibrosis of the anterior vaginal wall. But the confirmation of a ISD diagnosis is done through a urodynamic exam.