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The guideline recommendations to treat UI
-surgical treatment
The most commonly used technique for pts with OAB and UUI is
-bladder training (bladder drill, bladder retraining)
-fixed time interval  schedule
Bladder training should always be combined with
-urge inhibition techniques
-and often combined with anticholinergic therapy
Timed voiding involves
-having a patient void on fixed schedule
-typically every 2 to 3 hours-is intended to normilize frequency in a patient with  infrequent voiding and/or diminished bladder sensation
Bladder training is
- recommended as a first line treatment of UI in women
Level of evidence that the effect of bladder traning may be enchanced by drug therapy
-level 2
Smoking cessation on prevention or treatment of UI symptoms and recommendation of ICI committe
-no evidence based recommendation
Caffeine reduction in OAB patients
-has been advised
Fluid restriction and pts with SUI and OAB
-to obtain frequency-volume chart to try moderately restricting fluid intake
-it should be balanced against possible problems with bladder infections and constipation
obesity and UI
-but reversible cause of UI
Constipation and chronic straining
-may be risk factor fo UI (level 3 evidence)
Moderate exercise and incidence of UI
-decreases the incidence of UI
-in middle and older women
UI and depression
-there is a strong relationsip
Home training exercises
-Kegel exercises
-vaginal cones
-simple home perineometry
PFE (pelvic floor exercises) Kegel
-1/2 of pateints are unable to perform a proper contraction with simple instructions
-and up to 1/4 will actually promote UI with their efforts
PFMT (pelvic floor muscle training)
-is currently accepted term,replacing Kegel exerciseesICI
ICI points of PFMT
increase in strength occurs before visible hypertrophy
-early emproved strengtresults from neural adaptation
-hypertrophy begins only after minimum of 8 weeks and may continue for some years
Pregnancy and vaginal birth and UI
-are risk factors
Antepartum PFMT prevents
-postpartum UI
Grade of recommendation for PFMT postpartum
-grade C recommendation
PFMT shoud be pffered to all women with stress, urge or mixed incontinence (grade of recommendation)
-grade A
PFMT in men with prostatectomy UI
-may hastern return of continence after surgery
-it does not affect long term outcome
PFMT and stage I and II prolapse
-effectivnes in small pilot study
PFMT regimhas been proven most effective
adding clinic or home biofeedback to a PFMT program
-there is no demonstrable benefit
Sets of PFMT
-8-12 near maximal contractions
-each contraction is held 6 to 8 sec with an equivalent rest period
-at the end of each set series of 5 to 10 rapid contractions are performed
-the exercises are repeated five times per day,every other day
The most appropriate therapy for cognitive impaired  institutionalized ptient woth UI
-prompted voiding
Decreasing fluid intake by 25-50% from baseline resulted in
-statisitcaly significant improvements in UI
The current teaching from exercise physiology is
-every other day exercise of specific muscle groups
PFMT are recommended for preventing incontinence
-primiparous women
-and women after high risk deliveries
-0or delivery of large neonate
PFMT are recommended as first line therapy for
-established incontinence
Te mechanism or response to electrical stimulation
-is not completely understood
Posterior Tibial Nerve Stimulation
-the same effect with tolterodine
-contipation and dry mouth less common
-durability at 1 year
Urethral inserts
-passively occlud or coapt the urethra
-must be removed for voiding
-single use
Urethral inserts adverse effects
-UTI 30%
-hematuria 3 %
-migration 1,3%
The key information for planning use of conservative therapies comes from
-incontinence type
-bladder diary
-pelvic examination/muscle assessment
patients with good pelvic floor muscles should be treated with
-medical therapy (anticholinergic drugs)
Percent of women with SUI that respond to PFMT
Women become totaly dry after PFMT
Surgery vs PFMT
-surgery is superior
Bladder training and anticcholinergic medications
-should always be used when anticholinergic medications prescribed
Botox and urinary retention
-5-10% of cases
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