Autorzy przedstawili rys historyczny badań urodynamicznych, podkreślili znaczenie dobrze zebranego wywiadzie diagnostyce zaburzeń czynnościowych dolnych dróg moczowych. Scharakteryzowali poszczególne składowe postępowania wstępnego. Przypomnieli o istnieniu szeregu kwestionariuszy np. ICIQ-SF, UDI 6SF, Gaudenza, MESA pomocnych w szczegółowej ocenie zaburzeń.The authors have presented the historical background of urodynamic tests and emphasised the significance of wellcollected medical history to the diagnostics of lower urinary tract functional disorders. They have characterised the initial treatment. They pointed out the helpfulness of the questionnaires to be used: ICIQ-SF, UDI 6SF, the Gaudenz Questionnaire, MESA etc

Kopański, Zbigniew

Kowalska, A.

Krzemiński, D.

Maslyak, Z.

Sianos, G.

Sklyarov, I.

English

Jagiellonian Univeristy Repository

● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No.2/2017 ●  8   Abstract – The authors have presented the historical background of urodynamic tests and emphasised the significance of well-collected medical history to the diagnostics of lower urinary tract functional disorders. They have characterised the initial treatment. They pointed out the helpfulness of the questionnaires to be used: ICIQ-SF, UDI 6SF, the Gaudenz Questionnaire, MESA etc.   Key words - urinary incontinence, initial treatment.  Streszczenie – Autorzy przedstawili rys historyczny badań urody-namicznych, podkreślili znaczenie dobrze zebranego wywiadzie diagnostyce zaburzeń czynnościowych dolnych dróg moczowych. Scharakteryzowali poszczególne składowe postępowania wstępnego.  Przypomnieli o istnieniu szeregu kwestionariuszy np. ICIQ-SF, UDI 6SF, Gaudenza, MESA pomocnych w szcze-gółowej ocenie zaburzeń.  Słowa kluczowe - niedotrzymanie moczu, postępowanie wstępne.  Author Affiliations:  1. Collegium Masoviense – College of Health Sciences, Żyrardów  2. Faculty of Health Sciences, Collegium Medicum, Jagiel-lonian University  3. Glasgow Royal Infirmary Trauma and Orthopaedic De-partment Glasgow 4. Scientific and Research Institute of Haematology and Blood Transfusion, Kiev, Ukraine 5. Department of Therapy and Medical Diagnosis, Faculty of Postgraduate Education, Lviv National Medical University, Ukraine  Authors’ contributions to the article:  A. The idea and the planning of the study  B. Gathering and listing data  C. The data analysis and interpretation  D. Writing the article   E. Critical review of the article  F. Final approval of the article   Correspondence to:  Prof. Zbigniew Kopański MD PhD, Collegium Masoviense - College of Health Sciences, Żyrardów, G. Narutowicza 35 Str., PL-96-300 Żyrardów, Poland, e-mail: zkopanski@o2.pl  Accepted for publication: May 05, 2017.   I. INTRODUCTION  he history of urodynamic tests dates back to the 19th century. In 1872, in order to study the pressure in peri-toneal cavity, punctured a bladder and measured the pressure while the bladder was being filled. In 1876, Du-bois measured the pressure in the bladder depending on the body position. However, it was not until the 20th century that devices monitoring the filling and emptying of bladder were introduced. In 1959, Saul Boyarsky created the first urodynamic laboratory. Thanks to modern pressure meas-urement devices (microsensors etc.), digitalization, and the development of objective lower urinary tract disorder clas-sification systems, the 1980s and 1990s are considered a golden era in urodynamics [1-3].     II. INITIAL TREATMENT  The diagnostics of functional disorders of lower urinary tract is based mostly on well-prepared medical history and clinical symptoms. A helpful resource for the correct diag-nostics is “The Recommendations of the Polish Gynaeco-logical Society on the diagnostics and treatment of urinary incontinence in women”. The guidelines described there Urinary incontinence – introduction to diagnos-tics  (Niedotrzymanie moczu – wprowadzenie do diagnostyki) A Kowalska 1,A,D, D Krzemiński 1,F,C, Z Kopański 1,2,E, G Sianos 3,B, Z Maslyak 4,B,                  I Sklyarov 5,E T ● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No. 2/2017 (8-11) ●   ● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No.2/2017 ●  9  are in line with the recommendations by International Con-sultation of Incontinence (ICI) and International Conti-nence Society (ICS) (Figure 1). According to the aforemen-tioned source, the treatment of female patients with urinary incontinence is divided into [3-5]: 1) initial treatment 2) specialist diagnostic and therapeutic treatment The guidelines also state that whatever the proceedings applied initially, they should always be deemed “initial” [5,6].  Figure 1. Initial treatment in cases of urinary incontinence in women [7]   As initial assessment, the following steps need to be  taken [1,2]:  Getting the medical history,  Gynaecological examination,  Laboratory urinalysis,  Functional tests,  Implementing and keeping the urination frequency and volume diary.      The objectives of the basic assessment are [2,3]:  Assessing the nature of urinary system functional disorders (stress, urge, mixed, or overflow disor-ders).  Defining possible causes of the disorder (neurologi-cal ones, diabetes, menopause)  It has to be added that incontinence is very common in cases of multiple sclerosis, but also in cases of patients after strokes and with dementia. A neuro-logical examination is therefore recommended, but not obligatory. ● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No.2/2017 ●  10   Urinary tract infections can be manifested by noctu-ria (or nycturia, as both these names are common-ly used) and haematuria. The assessment of the treatment so far and the current pharmacotherapy.  Assessing a patient’s habits, such as liquid con-sumption, urination frequency, situations in which urination urge occurs etc.  A very important role is played by going into details when gathering the medical history data. That way, the oc-currence of the following symptoms caused by changes in the bladder and urethra can be either confirmed or ruled out [1,2,3]:  Symptoms related to urine being collected in the bladder, such as overactive bladder symptoms (urge urinary incontinence, urinary urgencies, in-creased urination frequency, nocturia); as well as pain disorders and stress;  Micturition-related symptoms — slow or interrupt-ed urine stream, urine dripping towards the end of micturition, or the necessity to support the micturi-tion with pressure;  Symptoms appearing after micturition – urine drip-ping and ailments related to the incomplete blad-der emptying;  Suspicious symptoms such as haematuria (presence of blood in urine) and dysuria (pain during urine flow), which may suggest bladder tumours or uri-nary tract infections. Thus, collecting full and comprehensive medical history involves finding out whether [8,9]:  The aforementioned symptoms occur?  What is their intensity and frequency?  What is the symptom frequency during day and night?  Are there any factors to mitigate those symptoms?  How can the patient adjust to the symptoms that oc-cur?  What is the impact of the aforementioned symptoms on the patient’s functioning and life?  There are many specialist questionnaires which help as-sess the symptoms in great detail. Some of them are: ICIQ-SF, UDI 6SF, the Gaudenz Questionnaire, MESA. They are all questionnaires recommended by the International Consultation on Incontinence. However, it has to be em-phasised that their diagnostic value varies depending on the incontinence type [10]. The basic question should be the one about the occur-rence of urinary incontinence and urgency. An affirmative answer automatically expands the medical history with the circumstances of incontinence or urinary urgency:  Incontinence when coughing, sneezing, exercising  Incontinence preceded by urgency  Polyuria during the day or night  Adequately formulated questions in the right order may lead to a preliminary suggestion as to the incontinence type [11]: a) Does incontinence occur when coughing, sneezing, or during exercise? b) Does incontinence occur when you do feel the urgen-cy, but you could not get to a restroom in time? c) Does incontinence occur with no physical activity and without urgency? d) Does incontinence occur equally frequently during exercises and when feeling the urgency?  If the patient selects the “a) answer”, this suggests stress urinary incontinence, at least in a major part. The recom-mendation in this case is to exercise pelvic floor muscles or to undergo a surgery. The choice of “b)” indicates urge incontinence, at least in a major part. These patients should be treated with anti-cholinergic medications (oxybutynin, solifenacin, toltero-dine, fesoterodine, darifenacin, trospium) plus intravaginal oestrogens in women with the symptoms of urogenital at-rophy. In case there is no recovery or the reaction is intol-erance, the application of botulinum toxin directly to the bladder must be considered. [12] In turn, an affirmative answer to “c)” means that there is another cause at stake. This requires further radiological and urodynamic diagnostics. Radiology provides very val-uable information for urinary incontinence diagnostics, scrutinizing the changes in topographic relations of the organs in minor pelvis. Front-back and lateral cys-tourethrography is performed while standing up and while lying down, before and during micturition. Additionally, a correct urography may provide similar kind of information without the risk of causing urinary tract infection [13]. Providing the “d)” response by a patient is a basis for di-agnosing mixed type of incontinence. In such a case, diag-nostics should be started from the most dominant symptom. The conclusions from the medical history should be sup-plemented with further diagnostic procedures [1,2].  Gynaecological examination In a physical gynaecological examination (which, sadly, is not always performed), the attention should be paid to [7]: ● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No.2/2017 ●  11   The presence of skin macerations and inflamma-tions in the pudendum area on vaginal vestibule – assessing the condition of the epithelium and the location of the external urethral orifice,  In vaginal area: examining the condition of mucosa and checking if the front vaginal wall is not low-ered (so-called cystocele), whether metroptosis exists, and whether ecchymosis, symptoms of at-rophy, or vaginal dryness are the case,  In urethra: assessing its sensitivity to palpation and flexibility,  In the pelvic floor: assessing the levator ani muscle condition,  In the uterus and adnexa: assessing if there are no tumours and if there are no tumours in the minor pelvis.   III. REFERENCES  [1] Khandelwal C., Kistler C. Diagnosis of Urinary Incontinence. Am Fam Physician 2013; 8: 543-550. [2] Abrams P, Cardozo L, Khoury S, et al. Incontinence. London; Health Publication Ltd, 2009. [3] Lucas MG, Bedretdinova D, Bosch JLHR, et al. Guidelines on Urinary Incontinence.  European Association of Urology, 2014.  [4] National Collaborating Centre for Women’sand Children’s Health. Urinary incontinence the management of urinary in-continence in women. RCOG Press at the Royal College of Obstetricians and Gynaecologists, 2006. [5] National Institute for Health and Clinical Excellence. Urinary incontinence. The management of urinary incontinence in women. quick reference guide 2006. [6] Narojczyk-Świeściak E. Nietrzymanie moczu u kobiet w wieku podeszłym. Nowa Klin 2012; 5: 5067-71. [7] Polskie Towarzystwo Ginekologiczne. Wytyczne Zespołu Ek-spertów odnośnie postępowania diagnostycznoterapeutyczne-go u kobiet z nietrzymaniem moczu i pęcherzem nadreak-tywnym. 150.254.179.40/.../expertus.cgi?...Nietrzymanie+moczu+-+leczenie+ [dostęp: 18.01.2017.] [8] Dadej R, Jędrzejczak-Dadej A. Nietrzymanie moczu – etiololo-gia i patogeneza. Geriatria 2009;2:38-47. [9] Dębliński P, Niezgoda T. Klasyfikacja nietrzymania moczu i sposoby leczenia. Prz Urol 2014; 5:12-18. [10] Thüroff JW, Abrams P, Artibani W, Haab F, Khoury S. et al. Clinical Guidelines for Management of Incontinence. Plym-outh; Health Publications Ltd., 2009. [11] Rechberger T, Kulik – Rechberger B. Zaburzenia czynnościo-we dolnych dróg moczowych. Forum Med Rodz 2010; 5: 20-26 . [12] Berghmans LC, Hendriks HJ, Bo K, Hay-Smith EJ,  et al. Conservative treatment of stress urinary incontinence in wom-en: a systematic review of randomized clinical trials. Br J Urol 1998; 82: 181-91.  [13] Bo K. Pelvic floor muscle exercise and urinary incontinence--train yourself continent!. Tidsskr Nor Laegeforen 2000; 120: 3583-89.  

Niedotrzymanie moczu : wprowadzenie do diagnostyki

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Niedotrzymanie moczu : wprowadzenie do diagnostyki

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