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Urinary incontinence is a common condition in women. All cases require a basic assessment, while urodynamic studies are indicated in those with complex or refractory symptoms. Initial treatment includes lifestyle advice, behavioural modifications, bladder retraining and pelvic floor muscle training. Synthetic mid-urethral sling procedures have revolutionized stress incontinence surgery and reduced the popularity of ‘traditional’ procedures, such as colposuspensions and pubovaginal slings. With regard to urgency urinary incontinence, antimuscarinic agents are the mainstay of current medical management, while a selective β3-adrenergic receptor agonist (Mirabegron) offers an alternative pharmacological option. Intravesical botulinum toxin and neuromodulation (peripheral or sacral) are available to women with refractory symptoms
Pad testing is most often used in the objective assessment of women with urinary incontinence. It involves the use of pre-weighed continence pads to capture urinary leakage over a period of time. The pads are then weighed to calculate the amount of leakage on completion of the test. The two most common methods used for pad testing are 1-hour and 24-hour tests. One-hour pad tests are performed in a clinical setting, under the supervision of a continence nurse or doctor. Twenty-four-hour tests are performed at home. Women are provided with a set of pads and advised not to modify their normal drinking or activities. The ICS Standardisation Committee has set out a standard protocol for the 1-hour pad test. Pad tests are of most value in the research setting before and after treatment, as an objective endpoint of urinary incontinence. Women's compliance with 24-hour pad tests decreases once cured.
Ultrasound of the bladder is used in clinical practice as a non-invasive estimate of bladder volume when assessing post-void urinary residual. Two types of ultrasound equipment are dedicated bladder scanner and standard linear array transabdominal or transvaginal ultrasound. Ultrasound of the bladder neck can be used to assess urethral hypermobility. Increased bladder neck mobility is associated with stress urinary incontinence. The volume of the urethral sphincter can be measured using three-dimensional ultrasound. Measurement of the thickness of the bladder wall has been validated using the transvaginal, transperineal, translabial or transabdominal approach. The ultrasound is likely to be used increasingly to provide the anatomical parameters in conjunction with functional parameters provided by urodynamics. Two-dimensional and three-dimensional ultrasounds have been employed to statically and dynamically image the pelvic floor. The application of ultrasound in the identification of levator injury is currently being used as a research tool.
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