Ambulatory trace over 2 minutes.There is leakage of about 20 ml in one epsiodes.The bladder is stable and there is a lot of movement.The patient is bending down and up again.Because the bladder is stable we can make the diagnosis Genuine stress incontinence.The ICS definitions may lag slightly behind current opinion. For example Ed McGuire of the Universtiy of Texas has made a significant contribution to the understanding of Genuine stress incontinence. He has defined 3 types of incontinence. These require urethral pressure measuremtns and x-ray visualisiation of the bladder neck under stress.
Type 1 incontinenceproximal urethral closure pressure >10 5mm from vesical outlet
leakage associated with minimal rotational descent of urethra <45 º
Type 2 incontinenceproximal urethral closure pressure >10 5mm from vesical outlet
leakage associated with gross rotational hypermobility >45 º
Type 3 incontinenceproximal urethral closure pressure <10 5mm from vesical outlet
non functioning “open” internal sphincter
leakage not necessarilly associated with rotational descent
The main change in understanding which McGuire brings is his finding that stress leakage due to raised abdominal pressure is not related to static urethral pressure profile.
|Schematic of x-ray of straining patient with |
type 1 & 2 leakage. Urethra is driven posteriorly
and inferiorly by raised abdominal pressure.
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