Materiały źródłowe

• #1 Urinary Incontinence Workup: Approach Considerations, Emergency Department Workup, Urinalysis and Urine Culture

  https://emedicine.medscape.com/article/452289-workup

  Patients with urinary incontinence should undergo a basic evaluation that includes a history, physical examination, and urinalysis. Additional information from a patient’s voiding diary, cotton-swab test, cough stress test, measurement of postvoid residual (PVR) urine volume, cystoscopy, and urodynamic studies may be needed in selected patients. Videourodynamic studies are the criterion standard for the evaluation of an incontinent patient but are typically reserved for the evaluation of complex cases of stress urinary incontinence. […] Most authorities agree that diagnosis from the history alone is not an adequate basis for surgical therapy. A review of the role of patient history in the diagnosis of urinary incontinence showed that a history of stress incontinence carries a sensitivity of about 0.91, but specificity is only 0.51. Positive predictive values in the range of 0.75-0.87 have been reported for a history of stress incontinence.

• #2 Urinary incontinence – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/diagnosis-treatment/drc-20352814

  It’s important to determine the type of urinary incontinence that you have, and your symptoms often tell your doctor which type you have. That information will guide treatment decisions. […] Your doctor is likely to start with a thorough history and physical exam. You may then be asked to do a simple maneuver that can demonstrate incontinence, such as coughing. […] After that, your doctor will likely recommend: Urinalysis. A sample of your urine is checked for signs of infection, traces of blood or other abnormalities. […] If further information is needed, your doctor may recommend more-involved tests, such as urodynamic testing and pelvic ultrasound. These tests are usually done if you’re considering surgery. […] Treatment for urinary incontinence depends on the type of incontinence, its severity and the underlying cause. A combination of treatments may be needed. If an underlying condition is causing your symptoms, your doctor will first treat that condition.

• #3 Urinary Incontinence Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/primary-care/urinary-incontinence/diagnosis.html

  To diagnose the cause of your urinary incontinence, your doctor will do a physical exam and ask about your past health. […] Your doctor may do some simple tests to look for the cause of your bladder control problem. […] Here are some tests that may be done to find the type and cause of your urinary incontinence. […] Urinalysis and urine culture. These tests show whether you have a urinary tract infection (UTI) or blood or sugar in your urine. […] Bladder stress test. It simulates the accidental release of urine that may occur when you cough, sneeze, laugh, or exercise. […] Pad test. This can help show how much urine is leaking. […] X-rays or ultrasound. These are used to examine changes in the position of the bladder and urethra when you urinate, cough, or strain. […] Urodynamic testing. It is typically done only if surgery is being considered or if treatment has not worked for you. […] Electromyogram (EMG). This test records the electrical activity of muscles. […] Cystoscopic exam. This is a test that allows your doctor to see inside the urinary tract by using a thin, lighted tube. […] Cystourethrogram. This is an X-ray of your bladder and urethra while you are urinating.

• #4 Diagnosis of Bladder Control Problems (Urinary Incontinence) – NIDDK

  https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems/diagnosis

  A health care professional will ask about your family and medical history and give you a physical exam. The exam will look for medical problems that may lead to accidental urine loss, also called urinary incontinence (UI). […] You may be asked to keep a bladder diary, and your health care professional may order labs and other diagnostic tests. […] Your health care professional may order one or more tests to help find the cause of UI. […] Urinalysis can test your urine for a bladder infection, a kidney problem, or diabetes. […] Blood tests can show problems with how well your kidneys work or a chemical imbalance in your body. […] Urodynamic testing, including electromyography, looks at how well parts of the urinary tractthe bladder, urethra, and sphinctersare storing and releasing urine. […] Cystoscopy is a procedure that uses a cystoscopea long, thin instrumentto look inside the urethra and bladder. […] Imaging tests can be used to take pictures of the inside of the body, including the urinary tract and nervous system.

• #5 Urinary Incontinence: Causes, Leakage, Types & Treatment

  https://my.clevelandclinic.org/health/diseases/17596-urinary-incontinence

  Urinary incontinence is a common condition that causes you to lose bladder control. A healthcare provider can determine the cause and recommend the right treatment for you. […] Urinary incontinence is when you lose control of your bladder and leak pee. Its a condition that can have a negative effect on your life. […] Urinary incontinence occurs when these parts dont operate as they should. This can happen for many different reasons throughout your life. […] Knowing the type of incontinence is an important part of your diagnosis and treatment plan. […] A healthcare provider can diagnose incontinence by reviewing your symptoms and medical history and performing a physical exam. […] These questions help a provider determine a pattern in your leakage, which helps them diagnose the type of incontinence.

• #6 Diagnosis of Urinary Incontinence | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0415/p543.html

  Urinary incontinence is common, increases in prevalence with age, and affects quality of life for men and women. The initial evaluation occurs in the family physician’s office and generally does not require urologic or gynecologic evaluation. The basic workup is aimed at identifying possible reversible causes. If no reversible cause is identified, then the incontinence is considered chronic. The next step is to determine the type of incontinence (urge, stress, overflow, mixed, or functional) and the urgency with which it should be treated. […] If the type of urinary incontinence is still not clear, or if red flags such as hematuria, obstructive symptoms, or recurrent urinary tract infections are present, referral to a urologist or urogynecologist should be considered. […] Guidelines for diagnosis and treatment of urinary incontinence were published in 2012 by the American Urological Association.

• #7 Diagnosing Female Urinary Incontinence | NYU Langone Health

  https://nyulangone.org/conditions/female-urinary-incontinence/diagnosis

  Urinary incontinence, a loss of bladder control, is common among women. Millions of women experience involuntary leakage of urine at some point in their lives. […] NYU Langone urologists and urogynecologists have extensive experience in diagnosing and treating urinary incontinence. […] After taking a medical history and conducting a physical and pelvic exam, your NYU Langone doctor orders tests that may help diagnose female urinary incontinence. […] Your doctor may ask you to keep a bladder diary, typically for three days. […] If your doctor suspects you have stress incontinence, he or she may perform a simple bladder stress test. […] An ultrasound, in which sound waves create images that are viewed on a computer monitor, may be used to assess how well your bladder empties after urination.

• #8 Urinary Incontinence test and diagnosis | Hospital Clínic Barcelona

  https://www.clinicbarcelona.org/en/assistance/diseases/urinary-incontinence/tests-and-diagnosis

  Generally undergo a diagnostic protocol to determine the type of urinary incontinence that the patient has that includes: […] Medical history. It will be review your family history, the diseases you have had, the course of any past pregnancies or births, and whether you have had any gynaecological problems. […] Symptom questionnaires. You will be asked to complete some short questionnaires to make the best possible evaluation of the symptoms. […] Physical examination. To detect physical abnormalities that could be related to the incontinence, such as potentially associated problems (scars from previous operations, abdominal hernias, skin lesions, etc.). […] Urine analysis A urine sample is analysed to rule out a urinary infection. […] Urinary diary or bladder record. A urinary diary is a daily record of the number of urinations and leaks, and the volume of fluid consumed. It helps the doctor to better understand your urinary incontinence and also identify behavioural habits that can be modified to achieve a significant improvement in the symptoms.

• #9 Urinary Incontinence | Stress Incontinence | UI | MedlinePlus

  https://medlineplus.gov/urinaryincontinence.html

  Urinary incontinence (UI) is the loss of bladder control, or being unable to control urination. It is a common condition. It can range from being a minor problem to something that greatly affects your daily life. In any case, it can get better with proper treatment. […] Your health care provider may use many tools to make a diagnosis: A medical history, which includes asking about your symptoms. Your provider may ask you to keep a bladder diary for a few days before your appointment. The bladder diary includes how much and when you drink liquids, when and how much you urinate, and whether you leak urine. […] Treatment depends on the type and cause of your UI. You may need a combination of treatments. Your provider may first suggest self-care treatments, including: Lifestyle changes to reduce leaks: Drinking the right amount of liquid at the right time, Being physically active, Staying at a healthy weight, Avoiding constipation, Not smoking. […] If these treatments do not work, your provider may suggest other options such as: Medicines, which can be used to Relax the bladder muscles, to help prevent bladder spasms, Block nerve signals that cause urinary frequency and urgency, In men, shrink the prostate and improve urine flow.

• #10 Stress incontinence – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/stress-incontinence/diagnosis-treatment/drc-20355732

  During your visit, your healthcare professional looks for clues to the cause of your symptoms. Your appointment will likely include: […] Urinary stress test, in which your healthcare professional looks for urine loss when you cough or bear down with a full bladder. […] Common cases of urinary incontinence often don’t need other tests. But sometimes your healthcare professional might order tests to see how well your bladder, urethra and sphincter work. […] Bladder function tests may include: […] Urodynamics is a test that measures pressure in your bladder during filling and emptying. This test can check for stress incontinence and the strength of the pelvic floor muscles. […] Cystoscopy. This test uses a scope that is put into the bladder to look for conditions in the bladder and urethra that may be causing your symptoms.

• #11 Urinary Incontinence Workup: Approach Considerations, Emergency Department Workup, Urinalysis and Urine Culture

  https://emedicine.medscape.com/article/452289-workup

  The more difficult question to answer is which battery of tests and examinations produces a high positive predictive value at the lowest cost and inconvenience to the patient. One study demonstrated the benefit of combining the following 4 factors to improve diagnostic accuracy: Predominant stress incontinence history, Postvoid residual (PVR) volume of no more than 50 mL, Positive cough stress test, Functional bladder capacity of at least 400 mL. […] Complex urodynamic testing in patients with these factors confirmed the diagnosis of stress incontinence 97% of the time; however, 15% of these patients also had coexisting detrusor instability. The positive predictive value, if one considers mixed incontinence as a separate disorder, is 82%. […] The VALUE study concluded that for women with uncomplicated, demonstrable stress incontinence, urodynamic studies offered no superiority when compared with office evaluation alone for outcomes at one year.

• #12 Urinary Incontinence – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559095/

  The evaluation of urinary incontinence should include a focused but detailed history and thorough physical examination. Potentially reversible causes, including abnormal sleep patterns, fluid overload, misuse of diuretics, and similar entities, should be identified. Medication reconciliation should be carried out, and comorbidities should be determined. […] Treatment and management of urinary incontinence depends on its type. Conservative, pharmacologic, and surgical treatment modalities exist. Medications should be reconciled, and substances such as caffeine and alcohol should be avoided if they are contributing to the patient’s incontinence. Treatment should begin with the least invasive methods and then escalate as appropriate. […] Establishing a differential diagnosis for urinary incontinence is crucial for identifying the specific type and underlying cause of the condition. This process involves distinguishing between various forms of incontinence, such as stress, urge, overflow, and functional incontinence, and ruling out other potential medical issues.

• #13 Diagnosis and testing for female urinary incontinence – Birmingham Urology Centre

  https://birminghamurologycentre.com/conditions/diagnosis-and-testing-for-female-urinary-incontinence/

  Your diagnosis will start with a discussion of your symptoms. Your doctor will ask you questions about your symptoms and medical history, which may include: How often your urinary incontinence occurs […] This involves recording information relating to your fluid intake and incontinence, such as: How often you need to urinate […] Your doctor may need to do a physical examination of your lower abdomen and pelvis. This may involve: Asking you to cough or laugh to see if any urine leaks this helps identify stress incontinence […] There are several tests that your doctor may need to perform, dependent on your symptoms. These may include: A sample of your urine may be tested. Tests can show whether you have a urinary tract infection […] Urodynamic tests are a series of tests to further check your bladder function. This can include urinating into a machine that measures your flow of urine

• #14 Urinary Incontinence Workup: Approach Considerations, Emergency Department Workup, Urinalysis and Urine Culture

  https://emedicine.medscape.com/article/452289-workup

  Urinary incontinence is not a common presenting complaint in the emergency department (ED); however, its presence is always abnormal. The role of the emergency physician is to rule out some of the serious causes such as cauda equina syndrome, cord compression, and paraspinal abscess, as well as, most commonly, overflow incontinence and infections. […] Depending on the clinical presentation, the following basic tests may be useful: Obtain a urinalysis and urine culture, as necessary, Hematuria should be evaluated as per American Urological Association hematuria guidelines, Check serum electrolytes and calcium levels, Check blood urea nitrogen (BUN)/creatinine levels; decreased muscle mass in elderly patients may affect kidney function measurement, Check glucose level, especially in diabetic patients or patients with polyuria or polydipsia.

• #15 Urinary Incontinence Workup: Approach Considerations, Emergency Department Workup, Urinalysis and Urine Culture

  https://emedicine.medscape.com/article/452289-workup

  In addition, specialists consulted on cases of urinary incontinence may request a variety of urodynamic studies for diagnosing the underlying cause. Such studies will be conducted on an outpatient basis. […] A screening urinalysis is generally recommended as part of the testing of women for urinary incontinence. In postmenopausal women, a urine culture should also be done. Cultures may show bacterial growth in patients whose urinalysis shows little or no evidence of inflammation. […] Patients with carcinoma in situ of the urinary bladder experience urinary frequency and urgency and show evidence of microscopic hematuria. Irritative voiding symptoms disproportionate to the overall clinical picture and/or persistent unexplained hematuria warrant urine cytology and cystoscopy. […] BUN and creatinine levels should be checked when poor kidney function, obstructed ureters, or urinary retention is suggested. This is especially important in the case of a stage III or stage IV cystocele.

• #16 Female Urinary Incontinence: Diagnosis & Treatments | NewYork-Presbyterian

  https://www.nyp.org/womens/urogynecology/female-urinary-incontinence/treatment

  During a physical exam, your doctor may perform simple tests to find possible causes of incontinence. […] Your doctor may ask you to provide a urine sample that can be tested for signs of various conditions that can cause urinary incontinence, including urinary tract infections (UTIs) or bladder cancer […] An ultrasound can help your doctor see any changes in your bladder’s position during urination […] This test involves examining the urethra and lining of the bladder and can help your doctor find signs of infections, stones, tumors, or bleeding […] During a pad test, you will wear a pad that has been weighed until you experience urine leakage. Your doctor will then weigh the pad again so they can determine the volume of urine leakage […] This group of tests includes more involved tests like pressure flow studies, uroflowmetry, electromyography, and video urodynamic tests. These tests mainly examine the flow of urine through the bladder and urethra. They are usually performed if previous treatments have not been effective for you or if surgery may be an option.

• #17 Diagnosing Overactive Bladder

  https://www.webmd.com/urinary-incontinence-oab/overactive-bladder-making-diagnosis

  There are a number of tests for overactive bladder, depending on your health history and symptoms. […] Tests for overactive bladder include: […] Taking a urine sample allows your doctor to check for conditions that can cause overactive bladder. […] This test checks to see whether the bladder empties fully by passing a flexible tube called a catheter through your urethra and into your bladder after you’ve urinated. […] To see whether you’re leaking urine, your doctor might do a bladder stress test, which consists of filling your bladder with fluid and then asking you to cough. […] This test uses sound waves to visualize the bladder and other parts of the urinary tract. […] This test uses a thin, lighted instrument called a cystoscope to visualize the inside of the urethra and bladder.

• #18 Urinary Incontinence Workup: Approach Considerations, Emergency Department Workup, Urinalysis and Urine Culture

  https://emedicine.medscape.com/article/452289-workup

  Measurement of postvoid residual urine volume, using either a bladder ultrasonography or urethral catheter, may be a part of the evaluation for urinary incontinence of patients with apparent failure to empty the bladder completely. […] Cystourethroscopy allows an anatomical assessment of the bladder and the urethra. The precise role of cystourethroscopy in the evaluation of female urinary incontinence is controversial. […] A pessary trial may be useful in the preoperative evaluation of female patients who have severe pelvic organ prolapse but no complaints of urinary incontinence. […] MRI remains investigational in the assessment of urinary incontinence. It is not used in clinical practice.

• #19 Urinary Incontinence Workup: Approach Considerations, Emergency Department Workup, Urinalysis and Urine Culture

  https://emedicine.medscape.com/article/452289-workup

  Testing for diabetes mellitus is not routine in the setting of urinary incontinence. However, it should be considered if polyuria and polydipsia are a part of the clinical picture or if diabetes risk factors are present and poor bladder emptying is found. […] Urodynamics are a means of evaluating the pressure-flow relationship between the bladder and the urethra for the purpose of defining the functional status of the lower urinary tract. The ultimate goal of urodynamics is to aid in the correct diagnosis based on pathophysiology. […] Simple urodynamic tests involve performing a noninvasive uroflow study, obtaining a postvoid residual (PVR) urine sample, and performing single-channel cystometrography (CMG). […] The most sophisticated study is videourodynamics, the criterion standard in the evaluation of a patient with incontinence.

• #20 OAB Diagnosis – Voices for PFD

  https://www.voicesforpfd.org/bladder-control/oab-diagnosis/

  Diagnosis of Overactive bladder/Urgency Urinary Incontinence will start with a thorough medical history. Your doctor will obtain a history of how often you urinate during the day and night and if you have an abnormal strong urge to urinate. Other important information is if you are leaking with urgency, at night and/or without any sensation. Documentation of pad use is also recorded. […] A urine sample is important to rule out a bladder infection. Your doctor may also check to make sure you are emptying your bladder. This can be done by either an ultrasound scan of the bladder or by passing a small catheter into the bladder to drain the remaining urine after voiding. […] A urodynamic test is the most common test to understand the function of your bladder and why you may be experiencing these bothersome urinary symptoms. […] Based on your history, your doctor may also want to perform a Cystoscopy which is a test that looks inside the bladder see the lining to rule out any bladder stone or cancer.

• #21 Evaluation of Uncomplicated Stress Urinary Incontinence in Women Before Surgical Treatment | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/06/evaluation-of-uncomplicated-stress-urinary-incontinence-in-women-before-surgical-treatment

  In the Value of Urodynamic Evaluation trial, only women with a postvoid residual urine volume of less than 150 mL were included in the study as meeting the a priori definition of uncomplicated SUI. […] Preoperative multichannel urodynamic testing is not necessary before planning primary anti-incontinence surgery in women with uncomplicated SUI, as indicated by observed urinary leakage from the urethra by provocative stress measures, a normal urinalysis result (without urinary tract infection), no POP beyond the hymen, and a normal postvoid residual urine volume. […] For women with uncomplicated SUI in whom conservative treatment has failed and who desire midurethral sling surgery, evidence indicates that the performance of preoperative multichannel urodynamic testing versus a basic evaluation does not affect treatment outcomes. […] However, women with complicated SUI may benefit from additional diagnostic evaluation with multichannel urodynamic testing, particularly before surgical treatment.

• #22 Diagnosis of Urinary Incontinence | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0415/p543.html

  Stress incontinence is caused by sphincter weakness, which leads to ineffective function. It is the most common cause of urinary incontinence in younger women and the second most common cause in older women. […] Urge incontinence is a result of detrusor overactivity, and can be further divided into two subtypes: sensory (a result of local irritation, inflammation, or infection within the bladder) or neurologic (most often caused by loss of cerebral inhibition of detrusor contractions). […] Overflow incontinence is caused by impaired detrusor contractility, bladder outlet obstruction, or both, resulting in overdistension of the bladder. […] A measurement of postvoid residual (PVR) urine is recommended to diagnose overflow incontinence. […] If the cause of urinary incontinence is unclear after the assessment, referral to a urologist or urogynecologist is recommended.

• #23 Evaluation of Uncomplicated Stress Urinary Incontinence in Women Before Surgical Treatment | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/06/evaluation-of-uncomplicated-stress-urinary-incontinence-in-women-before-surgical-treatment

  Stress urinary incontinence (SUI) is a condition of involuntary loss of urine on effort, physical exertion, sneezing, or coughing that is often bothersome to the patient and frequently affects quality of life. […] The minimum evaluation before primary midurethral sling surgery in women with symptoms of SUI includes the following six steps: 1) history, 2) urinalysis, 3) physical examination, 4) demonstration of stress incontinence, 5) assessment of urethral mobility, and 6) measurement of postvoid residual urine volume. […] Stress urinary incontinence should be objectively demonstrated before any anti-incontinence surgery is performed. […] Anti-incontinence surgery is more successful in women with urethral mobility, defined as a 30 degree or greater displacement from the horizontal when the patient is in a supine lithotomy position and straining.

• #24

  https://journals.lww.com/greenjournal/fulltext/2014/11000/diagnosis_and_surgical_treatment_of_stress_urinary.22.aspx

  Stress urinary incontinence (SUI) is a major problem affecting more than 20% of the nation’s female population, with increasing prevalence as our population continues to age. Incontinence places a great burden on individuals, and the economic effect is large. Stress urinary incontinence occurs when there is involuntary leakage of urine during coughing, laughing, sneezing, or physical activity. It can be diagnosed during physical examination and by using low-cost office diagnostics. […] Although nonsurgical treatments provide some benefit, surgical interventions have demonstrated superiority with respect to subjective and objective cure and better long-term improvement. Corrective surgeries for SUI can be grouped into four categories: 1) slings (midurethral slings and slings placed at the ureterovesical junction), 2) retropubic urethropexy, 3) urethral bulking agents, and 4) artificial sphincters. The success and failure of each approach needs to be assessed in the context of individual patients and their circumstances. Slings and retropubic urethropexy are considered first-line surgical options.

• #25 Urge Incontinence: Causes, Symptoms, & Treatment

  https://my.clevelandclinic.org/health/diseases/22161-urge-incontinence

  Urge incontinence is a type of urinary incontinence that causes an urgent, uncontrollable need to pee several times during the day and night. Treatment may include Kegel exercises and therapies like botulinum toxin and nerve stimulation. […] Urge incontinence causes you to need to use the restroom immediately. Overactive bladder is a common cause of urge incontinence. It makes your bladder muscles squeeze before you need to go. […] The most common cause of urge incontinence is an overactive bladder. An overactive bladder causes muscles in your bladder to squeeze (contract) more than they should. This makes you feel like you have to pee before your bladder is actually full. […] The main sign of urge incontinence is an urgent, uncontrollable need to pee that results in leakage. […] A healthcare provider will review your medical history and ask about your symptoms to diagnose urge incontinence. Additional workup will include a physical exam.

• #26 The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/idiopathic-overactive-bladder

  In the initial office evaluation of patients presenting with symptoms suggestive of OAB, clinicians should: obtain a medical history with comprehensive assessment of bladder symptoms, conduct a physical examination, and perform a urinalysis to exclude microhematuria and infection. (Clinical Principle) […] Clinicians may offer telemedicine to initially evaluate patients with symptoms suggestive of OAB, with the understanding that a physical exam will not be performed and urinalysis should be obtained at a local laboratory (or recent lab results reviewed, if available). (Expert Opinion) […] Clinicians may obtain a post-void residual in patients with symptoms suggestive of OAB to exclude incomplete emptying or urinary retention, especially in patients with concomitant voiding or emptying symptoms. (Clinical Principle)

• #27 Urge Incontinence: Causes, Symptoms, & Treatment

  https://my.clevelandclinic.org/health/diseases/22161-urge-incontinence

  Urge incontinence usually doesn’t go away on its own. But treatments can help alleviate your symptoms. […] According to your responses and the results of any testing, a provider may recommend pelvic floor physical therapy, bladder retraining, and lifestyle changes. […] If bladder retraining and lifestyle changes don’t help, a healthcare provider may recommend botulinum toxin (Botox) injections or neuromodulation. […] Urge incontinence can cause you a lot of stress. At-home therapies, like Kegel exercises and bladder retraining, can help reduce urge incontinence. […] Talk to a healthcare provider when you first notice symptoms of urge incontinence or changes in your bathroom habits. They can help determine what’s causing urge incontinence and help treat it or manage your symptoms.

• #28 OBM Geriatrics | Mixed Urinary Incontinence: Diagnosis and Management

  https://www.lidsen.com/journals/geriatrics/geriatrics-07-04-251

  The evaluation and treatment of mixed urinary incontinence receives relatively little attention as compared to other forms of incontinence. Mixed incontinence, however, defined as the combination of stress and urgency incontinence, accounts for the largest proportion of incontinence, with an increased incidence in older women. […] Evaluation requires a careful assessment of the impact on QOL and goals of care and may need to involve caregivers and/or family members in the discussion, in addition to considerations of more advance evaluation on an individual basis prior to invasive treatments. […] The diagnosis of MUI can be particularly challenging for multiple reasons. The challenge is additionally compounded in older women in which there are special considerations of the risks and benefits of pursuing invasive testing.

• #29 OBM Geriatrics | Mixed Urinary Incontinence: Diagnosis and Management

  https://www.lidsen.com/journals/geriatrics/geriatrics-07-04-251

  Incontinence history can and should be pursued in this setting, as a primary care provider is the most common healthcare professional seen by older women and is most likely the longest-standing patient-provider relationship, therefore providing a safe and comfortable environment for women to discuss sensitive issues. […] This suggests that while primary care providers understand the burden of UI to women, they are not utilizing their patient interactions to screen for UI. […] The first step of evaluation is always a careful history. However, several studies have indicated that patient history is not always accurate as the sole determinant of UI type, which can be particularly challenging in a patient with MUI. […] Physical examination is a necessary and important component of the evaluation, even when the history obtained may seem straightforward.

• #30 OBM Geriatrics | Mixed Urinary Incontinence: Diagnosis and Management

  https://www.lidsen.com/journals/geriatrics/geriatrics-07-04-251

  The information gained from the overall general appearance of the patient can be incredibly valuable, particularly in older patients. […] It is worth considering a formal assessment of frailty in the older population during assessment for UI, as there is surmounting evidence that the clinical phenotype of frailty predisposes this population to poorer surgical outcomes and increased post-operative complications. […] The diagnosis of MUI in older women should start with routine screening and specialty referral for advanced evaluation as needed. […] While the literature is quite limited, there are numerous treatment options available for MUI which range from observation to invasive surgery, each with its own risks and benefits, with many unique considerations in the older patient.

• #31 Mixed Incontinence in Women | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/mixed-incontinence-in-women

  If you have incontinence, keeping a urinary diary a record of your daily urination, urine accidents and fluid intake can help us make the proper diagnosis and decide on the appropriate treatment. […] At your first visit to UCSF, your provider will ask questions about your general health, your history of incontinence, past surgeries, illnesses and medications you are taking. The provider will also perform a physical examination, including a pelvic exam. In addition, a urine sample will be tested. If your problem is complex, additional tests may be done at a later visit. […] Depending on the particular details of your medical history, your doctor may proceed to any or all of the following physical evaluations. […] A urinary diary provides details about your fluid intake and urine output, which can be crucial to making the right diagnosis.

• #32 Urinary Incontinence in Adults – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/voiding-disorders/urinary-incontinence-in-adults

  Overflow incontinence is dribbling of urine from an overly full bladder. […] Functional incontinence is urine loss due to cognitive or physical impairments (eg, due to dementia or stroke) or environmental barriers that interfere with control of voiding. […] Mixed incontinence is any combination of the above types. […] The disorder tends to differ among age groups. […] In postmenopausal women, decreased estrogen levels lead to atrophic urethritis and atrophic vaginitis and to decreasing urethral resistance, length, and maximum closure pressure. […] In men, prostate size increases, partially obstructing the urethra and leading to incomplete bladder emptying and strain on the detrusor muscle. […] Established incontinence is caused by a persistent problem affecting nerves or muscles.

• #33 Diagnosis and management of urinary incontinence in residential care | British Columbia Medical Journal

  https://bcmj.org/articles/diagnosis-and-management-urinary-incontinence-residential-care

  A review of symptoms and quick external observation for atrophic changes in the perineum are key to diagnosing vaginitis or urethritis, conditions common in frail postmenopausal women. […] If urinary incontinence persists after assessment and management of reversible causes, the next step is to investigate and address structural causes. […] Urge incontinence results from overactive bladder (OAB), a disorder characterized by symptoms of nocturia, frequency, and urgency. […] Diagnosis can be made with a post-void residual urine test, either by in-and-out catheterization or, preferably, by portable ultrasound bladder scanner. […] Overflow incontinence should be identified and managed. […] Mobility and other factors that affect ease of voiding can worsen incontinence. […] Urinary incontinence is particularly common in persons with moderate to severe dementia, and is a marker of worsening disease.

• #34 Diagnosis and management of urinary incontinence in residential care | British Columbia Medical Journal

  https://bcmj.org/articles/diagnosis-and-management-urinary-incontinence-residential-care

  Indwelling catheters are used almost exclusively for chronic urinary retention not amenable to surgical treatment or for keeping urine away from healing wounds. […] Transient and structural urinary incontinence can be effectively managed even in frail residents. […] Even for those residents with persistent incontinence, facility practices can reduce the morbidities and indignities accompanying loss of bladder control and improve resident quality of life.

• #35 Urinary Incontinence – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559095/

  Response to treatment and management varies among patients. For those whose symptoms cannot be eliminated, optimal symptom control should be sought by multiple treatment modalities. […] Urinary incontinence can lead to many complications that significantly impact a patient’s health and quality of life. These complications range from physical issues, such as skin infections and urinary tract infections, to psychological effects, including anxiety and depression. […] Consultations play a vital role in effectively managing urinary incontinence, ensuring comprehensive care tailored to individual patient needs. These consultations involve specialists such as urologists, gynecologists, and geriatricians, who provide expertise in diagnosing the type and severity of incontinence. […] Deterrence and patient education are crucial in effectively addressing urinary incontinence. Patients and their families should be informed that although urinary incontinence is highly prevalent in older adults, it is not a normal part of aging. They should be aware that many causes of urinary incontinence are reversible, and all cases are treatable to some degree.

• #36 Diagnosis & non-surgical management of urinary incontinence | IJGM

  https://www.dovepress.com/diagnosis-and-non-surgical-management-of-urinary-incontinence–a-liter-peer-reviewed-fulltext-article-IJGM

  It is important to enquire about red flag symptoms, which require further investigations, such as pain, hematuria, recurrent UTI or significant voiding or obstructive symptoms as these may indicate issues such as underlying malignancy. […] A search of the Medline/PubMed electronic database was performed for dates up to February 2021. […] A bladder or voiding diary typically records the type and volume of fluid intake, incontinence episodes and number of pads used along with a recorded chart of urinary frequency and voided urine volume. […] Conservative management should be the starting point for any patient with UI. […] Conservative therapies are recommended as they can be effective and well tolerated and are usually associated with the least risk of harm. […] Many elderly patients will suffer from multiple medical conditions that can be associated with lower urinary tract symptoms, including UI.

• #37 Urinary Incontinence Treatment/Prevention – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/obgyn/urogynecology/diagnosis-treatment-and-prevention-of-urinary-incontinence

  More than 75 percent of women can experience significant improvement in their incontinence symptoms with appropriate diagnosis and treatment. […] It is critical that the correct diagnosis for the type of urinary incontinence be made prior to instituting a treatment plan. […] Most often, the diagnosis can be made in the office and does not require complex or invasive testing. […] The diagnosis starts with a complete history and physical exam which can often determine the cause of urinary incontinence. […] Office-based testing can help to further determine and characterize urinary incontinence. […] Treatment is customized for each patient based on their diagnosis, severity of condition, age, and ability to comply with treatment recommendations. […] However, treatments may vary depending on the severity of the condition and the age of the patient as well as exam/test findings.

• #38 Urinary incontinence – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/diagnosis-treatment/drc-20352814

  Your doctor may recommend that you do these exercises frequently to strengthen the muscles that help control urination. Also known as Kegel exercises, these techniques are especially effective for stress incontinence but may also help urge incontinence. […] Medications commonly used to treat incontinence include: Anticholinergics. These medications can calm an overactive bladder and may be helpful for urge incontinence. […] During sacral nerve stimulation, a surgically implanted device delivers electrical impulses to the nerves that regulate bladder activity. […] If other treatments aren’t working, several surgical procedures can treat the problems that cause urinary incontinence: Sling procedures. […] If medical treatments can’t eliminate your incontinence, you can try products that help ease the discomfort and inconvenience of leaking urine: Pads and protective garments.

• #39 The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/idiopathic-overactive-bladder

  Clinicians may use telemedicine for follow-up visits with patients with OAB. (Expert Opinion) […] Clinicians should engage in shared decision-making with patients with OAB taking into consideration the patients expressed values, preferences, and treatment goals in order to help them make an informed decision regarding different treatment modalities or to explore the option of no treatment. (Clinical Principle) […] Clinicians should discuss incontinence management strategies (e.g., pads, diapering, barrier creams) with all patients who have urgency urinary incontinence. (Expert Opinion) […] Clinicians should offer bladder training to all patients with OAB. (Strong Recommendation; Evidence Level: Grade A) […] Clinicians should offer behavioral therapies to all patients with OAB. (Clinical Principle)

• #40 The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/idiopathic-overactive-bladder

  Clinicians may offer select non-invasive therapies to all patients with OAB. (Clinical Principle) […] In patients with OAB whose symptoms do not adequately respond to monotherapy, clinicians may combine one or more of the following: behavioral therapy, non-invasive therapy, pharmacotherapy, and/or minimally invasive therapies. (Expert Opinion) […] Clinicians should counsel patients that there is currently insufficient evidence to support the use of nutraceuticals, vitamins, supplements, or herbal remedies in the treatment of patients with OAB. (Expert Opinion) […] Clinicians should offer antimuscarinic medications or beta-3 agonists to OAB patients to improve urinary urgency, frequency, and/or urgency urinary incontinence. (Strong Recommendation; Evidence Level: Grade A) […] Clinicians should counsel patients with OAB on the side effects of all oral medication options; treatment should be chosen based on side effect profiles and in the context of shared decision-making. (Clinical Principle)

• #41 Urinary Incontinence Treatment/Prevention – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/obgyn/urogynecology/diagnosis-treatment-and-prevention-of-urinary-incontinence

  In addition, patients with complaints of overactive bladder or urinary incontinence should be evaluated soon after the onset of the condition as patients with mild symptoms often have greater success with more conservative treatment options. […] Treatment of long-standing disease often involves more aggressive treatment with lower success rates.

• #42 Urinary Incontinence & Bladder Function Tests for Women

  https://www.webmd.com/urinary-incontinence-oab/doctors-test-urinary-incontinence-women

  Your doctor might need more information to diagnose your condition. If so, they’ll perform what’s known as a special test. […] Urodynamic testing. Your bladder is filled with water, via a catheter. At the same time, a monitor measures the pressure that builds against your bladder walls. It also tests the strength of the muscle that controls the urine flow from your bladder. This helps to gauge what type of urinary incontinence you have.

• #43 Urinary incontinence – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/diagnosis-treatment/drc-20352814

  But effective treatments are available for urinary incontinence. It’s important to ask your doctor about treatment. Once you do, you’ll be on your way to regaining an active and confident life. […] If you have urinary incontinence, you’re likely to start by seeing your primary care doctor. You may be referred to a doctor who specializes in urinary tract disorders (urologist) or a gynecologist with special training in female bladder problems and urinary function (urogynecologist).

• #44 Diagnosis and Tests for Urinary Incontinence | American Geriatrics Society | HealthInAging.org

  https://www.healthinaging.org/a-z-topic/urinary-incontinence/tests

  To diagnose the type of urinary incontinence you have, your healthcare provider will ask you several questions about your symptoms, such as: […] Your provider will do a physical examination. This exam may include a pelvic examination for women and a prostate examination for men. Other things your provider may do to help make the diagnosis include: […] Usually, only the urinalysis is definitely needed. Your provider may or may not need to do the other tests, depending on your situation. Your provider may refer you to see a specialist such as a urologist, urogynecologist (gynecologist who specializes in pelvic and bladder problems), or geriatrician. […] Less commonly, your provider or a specialist may recommend special tests, such as:

• #45 Urinary Incontinence in Women: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0915/p339.html

  Management of mixed UI should be directed toward treating predominant symptoms. […] Subspecialist referral should be considered for complicated UI to include associated pain, persistent hematuria or proteinuria, significant pelvic organ prolapse, previous pelvic surgery or radiation, suspected fistula, or elevated postvoid residual.

• #46 Urinary Incontinence: Causes, Leakage, Types & Treatment

  https://my.clevelandclinic.org/health/diseases/17596-urinary-incontinence

  A healthcare provider may order the following tests to help diagnose incontinence: Pelvic exam, Digital rectal exam, Pee test (urinalysis), Bladder ultrasound, Stress test, Cystoscopy, Urodynamic tests, Pad test. […] A healthcare provider must diagnose the type of continence. Theyll also talk to you about the available treatments and help you choose the one youre most comfortable with. […] A provider may suggest surgery to treat your incontinence. […] Sometimes, urinary incontinence is a short-term issue that goes away once the cause ends, such as a UTI. But incontinence also has long-term causes. […] Talk to a healthcare provider when you first notice leakage or changes to your bathroom habits. They can help determine the cause and type of incontinence and help treat or manage it.

• #47 Female urinary incontinence: Evaluation – UpToDate

  https://www.uptodate.com/contents/female-urinary-incontinence-evaluation

  Female urinary incontinence, the involuntary leakage of urine, is common and undertreated. It is estimated that approximately 60 percent of adult women experience urinary incontinence, yet only 25 to 61 percent of symptomatic community-dwelling women seek care. Patients may be reluctant to initiate discussions about their incontinence and urinary symptoms due to embarrassment, lack of knowledge about treatment options, and/or fear of surgery. […] This topic will review the epidemiology, risk factors, etiology, and initial evaluation of the nonpregnant woman with urinary incontinence.

• #48 Diagnosis & Treatment | Female Urinary Incontinence | Urology Services | University Hospitals | Cleveland, OH | University Hospitals

  https://www.uhhospitals.org/services/urology-services/conditions-and-treatments/incontinence-and-bladder-control/female-urinary-incontinence/diagnosis-treatment

  For women experiencing symptoms of urinary incontinence, it is essential to talk to a medical professional with experience and expertise in female urological health. […] an accurate diagnosis must be the first step. […] At your initial appointment, the specialist will take a complete medical and family history and conduct a physical exam. […] The information gathered will be very helpful in diagnosing your condition. […] After a comprehensive evaluation and the appropriate diagnostic testing, our urologists will work in close partnership with gynecologists and female pelvic health professionals to create an individualized treatment plan. […] Treatment recommendations may include one of more of the following: Noninvasive treatments and lifestyle changes, Urethral fillers, Electrical stimulation therapy, Surgery.

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