1. Tjahjodjati Subdivision Urology Surgery Department, Medical Faculty Padjadjaran University / Hasan Sadikin Hospital

2. DEFINITION URINARY INCONTINENCE IS DEFINED AS THE INVOLUNTARY LEAKAGE OF URINE,PERCEIVED BY THE SUFFERER, AS A SOCIAL OR HYGIENE PROBLEM.

3. 1. 1. Urge Urinary Incontinence The involuntary leakage of urine accompanied by or immediately proceeded by urgency

4. 2. Stress Urinary Incontinence The complaint of involuntary leakage of urine on effort or exertion, or sneezing or coughing

5. 3. Overflow Urinary Incontinence The complaint of involuntary leakage of urine due to overdistention of bladder. It is usually caused by infravesical obstruction or flaccid bladder.

6. 4. Reflex Urinary Incontinence The complaint of leakage of urine due to detrusor involuntary

7. 5. Continous Urinary Incontinence : The complaint of continous urine leakage. It is caused usually by urinary fistula,ex: vesicovaginal fistula,ureterovaginal fistula, extopic ureter, extrophia bladder. 6. Nocturnal Enuresis : The complaint of involuntary loss of urine that occurs during sleep 7. Mixed Urinary Incontinence : is mixed of urge and stress urinary incontinence

8. NEURAL CONTROL OF MICTURITION

9. MICTURITION AND URINE STORAGE

10. Bladder Filling & Emptying Cycle 1. Bladder fills 2. First desire to urinate (bladder half full) 3. Urination voluntarily inhibited until time and place are right The cycle of bladder filling and emptying Urination Detrusor muscle contracts Urethral sphincter relaxes Urethral sphincter contracts Detrusor muscle relaxes

11. History How long symptoms exist, any correlation with strainning (coughing or laughing), voiding sensation History of Surgery : Urology or Gynecology Patient Mobility : Handicap to go to the toilet Mental Status : Dementia, Psychologycal Problem Medication/Drugs : Sedative Hypnosis, Diuretic, Antidepresant Concomitant Disease : Asthma Brochiale, COPD Obstretrical History : Pregnancy, Delivery, High Birth Weight

12. Impact of Incontinence to the person’s Quality of Life : Severity of Symptoms : Voiding Diary chart

14. Physical Examination General Status Supra pubic : full bladder or not,pain External genital : Perineum : skin rash, eritema, uterine prolaps, cystocele, rectocele, strictur, stone Neurologic : sensation, reflex bulbocavernosus Rectal : prostat, feces consistency, sphincter tone

15. Laboratory Examination Urinalysis : UTI, Hematuria Post void Residual Urine Uroflowmetri PAD Test Urodynamic Imaging : BNO-IVP, USG

18. STRESS INCONTINENCE

19. Directed to the Etiology : Stress U.I Pelvis Floor Excercises Weighted Vaginal Cone Electro Stimulation Surgery : - TVT - Kolposuspension

20. Urge U.I Bladder Retraining Medication : anti muscarinic agent Surgery Overflow U.I : Relief the obstruction (surgery) Continous U.I: Treat the Etiology/ close the fistula/defect (surgery)

21. THANK YOU FOR YOUR ATTENTION