In the name of God

UI: evaluation Dr. reza aghelnezhad Urologist, endourology fellowship KUMS

DIAPPERS: causes of transient incontinenc

History:

History of Present Illness 1 The incontinence should first be characterized subjectively. Does the leakage occur (1) with physical activity? (2) with a sense of urgency? or (3) without sensory awareness? If the nature of the incontinence is mixed, does one component cause more bother or occur more frequently than the other?

History of Present Illness 2 Second, the leakage should be quantified if possible. Appraisal of the degree of leakage before therapy can be helpful during postoperative assessment of treatment impact. For the purposes of routine outpatient assessment, this quantification can be achieved on the basis of the number of pads used per day or the frequency of clothing changes due to urinary leakage. In the setting of research or an academic practice, more stringent and objective measures such as pad weight testing are often used.

History of Present Illness 3 Third, the voiding pattern should be defined. What is the frequency of urination during the day? During the night? Are there any obstructive symptoms? Does the patient feel as though he or she empties the bladder completely? Is the stream strong? Does the stream fluctuate during the void? Is it necessary to strain to empty the bladder?

History of Present Illness 4 Fourth, establishment of the duration of symptoms and any inciting events that contributed to the onset of leakage is important. Did the leakage follow a pregnancy or a vaginal delivery or start after a fall, or trauma or pelvic or back surgery? has there been any prostate or urethral surgery? Are there any neurologic symptoms such as numbness or tremor?

History of Present Illness 5 Finally, it is helpful to determine the impact that the leakage has on the patient’s daily life and activities. Does the incontinence limit the individual’s activity? Has the patient changed his or her lifestyle due to the threat of leakage?

Past medical and surgical histories Neurologic conditions: Parkinson, stroke Medical diagnoses: COPD, DM radiation therapy trauma gynecologic and obstetric history: gravity, parity, and hormonal status previous pelvic surgery smoking

Medications Sympathomimetics Sympatholytics Anticholinergics Diuretics

PHYSICAL EXAMINATION General appearance Estrogen status Urethral position and mobility Assessment of prolapse Neurologic examination Bulbocavernosus reflex Digital rectal examination

POP-Q staging

POP-Q criteria

evaluation Urinalysis PVR measurement Voiding diaries Questionnaires& quality of life instruments Pad tests Dye tests Cystoscopy Urodynamics

Radiographic imaging Voiding cystourethrogram Ultrasound Magnetic resonance imaging