4th Annual Jefferson Urology Symposium: Focus on Urinary Incontinence

© The Canadian Journal of Urology TM : International Supplement, August 2021 Evaluation and management of female urinary incontinence Andrew A. Denisenko, Cassra B. Clark, MD, Maria D’Amico MD, Alana M. Murphy, MD Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA DENISENKO AA, CLARK CB, D’AMICO M, MURPHY AM. Evaluation and management of female urinary incontinence. Can J Urol 2021;28 (Suppl 2):27-32. Introduction: Urinary incontinence (UI) is a common condition in all demographics of women and consists of stress UI (SUI), Urgency UI (UUI), and mixed UI (MUI). Treatment includes lifestyle modifications, medical treatment, and surgery depending on the type of UI and severity of symptoms. This review is an update on the evaluation and management of UI in women. Materials and methods: This review article covers the evaluation and management options for UI in women and includes the most recent guidelines from the American Urological Association (AUA) as well as recently published literature on the management of UI. Results: Any evaluation of UI should include a thorough targeted history and physical, and counseling for treatment should consider patient goals and desired outcomes. For both SUI and UUI, behavioral therapy and lifestyle modifications are effective first line treatments. Patients with UUI can benefit frommedical therapy which includes anticholinergics and ß3-agonist medications, as well as neuromodulation in treatment refractory patients. SUI patients may further benefit frommechanical inserts which prevent leaks, urethral bulking agents, and surgical treatments such as the mid urethral sling and autologous fascial pubovaginal sling. Conclusions: Treatment of UI in women requires a graded approach that considers patient goals and symptom severity, beginning with lifestyle and behavioral modifications before progressing to more aggressive interventions. Key Words: urinary incontinence, stress urinary incontinence, urgency urinary incontinence, mid urethral sling, autologous fascial pubovaginal sling Address correspondence to Andrew A. Denisenko, Department of Urology, Thomas Jefferson University, 1025 Walnut Street, Suite 1100, Philadelphia, PA 19107 USA Introduction Urinary Incontinence (UI) is common across all demographics of women and is characterized by the involuntary loss of urine. UI can be divided into three subtypes: stress urinary incontinence (SUI), urgency urinary Incontinence (UUI), and mixed urinary incontinence (MUI). Risk factors for UI include age, race/ethnicity, body mass index (BMI), parity, smoking, diabetes, and hysterectomy. 1 Data from a national survey of women in the United States shows that 49.6% of women report having some form of UI. 2 When broken down by subtype, 49.8% of that group have SUI, 34.4% have MUI, and 15.9% have UUI. Longitudinal studies have reported the incidence of SUI to range from 4%-11% per year, and recent estimates for the United States estimate that the number of women with UI will increase from 18 million in 2010 to 28.4 million in 2050. 3-5 Idiopathic overactive bladder (OAB) is considered a symptom complex as opposed to a single, discrete disease. 6 The prevalence of OAB in women in the United States has been estimated to be as high as 43%. 7 It is defined by urinary urgency, where UUI may occur but is not necessarily present, with no signs of urinary tract infection (UTI) or other obvious underlying pathology (i.e. neurogenic bladder). Urgency can also be accompanied by urinary frequency and nocturia. Urinary frequency is defined as urination that occurs more often than the normal interval. Nocturia is the interruption of sleep in order to void one or more times. UUI results when there is involuntary loss of urine associated with urgency. SUI is the most common manifestation of UI, being found in about 50% of women with symptoms of 27