Management Figure 2. Specialist Management of Urinary Incontinence in Women
Incontinence on physical activity
Incontinence with mixed symptoms
Incontinence with urgency/ frequency
> Assess for pelvic organ prolapse > Consider cystourethroscopy > Consider imaging of urinary tract/pelvic floor (x-ray, fluoroscopy, or ultrasound) > Urodynamic evaluation: ▶ Uroflowmetry (evaluates emptying dysfunction) ▶ Cystometry (evaluates sensory and storage function) ▶ Urethral pressure profile and leak point pressures (assesses sphincter function) ▶ Reduction stress testing if prolapse ≥ stage 3
incontinence
Urodynamic stress
incontinence Mixed
overactivity incontinence
Detrusor
Incontinence associated with poor bladder emptying (PVR)
If initial therapy for stress incontinence failed, consider: > Periurethral bulking agent injection
> Sling > Retropubic suspension
> Artificial urinary sphincter
If initial therapy for urge incontinence failed, consider: > Neuromodulation > Botulinum toxin A
> Bladder augmentation
intravesical injectionsa
> Alternative: non- surgical treatments
> Urinary diversion > Detrusor myectomy
Bladder outlet obstruction: > Correct
> Intermittent catheterization
> Alternative: non- surgical treatments
a FDA approved for the treatment of urinary incontinence due to detrusor overactivity associated with a neurologic condition (eg, spinal cord injury [SCI], multiple sclerosis [MS]) in adults who have an inadequate response to or are intolerant of an anticholinergic medication.
obstruction (address prolapse, release urethral obstructive surgery)
Underactive detrusor: > Intermittent
> Suprapubic catheter
catheterization
> Alpha antagonist > Neuromodulation
