INKONTINENSIA URIN

PADA WANITA
dr. I Gede Mega Putra, SpOG (K)
Divisi Uroginekologi Rekonstruksi
Bag / SMF Obgin FK UNUD / RSUP Sanglah
Denpasar
Definisi ~ ICS
Urinary incontinance is the involuntary
loss of urine wich is objectively
demonstrable and social or hygiene
problem (1996)

Urinary incontinance is the involuntary loss

of urine (2002)
Tipe inkontinensia urin pada wanita
1. Stress incontinence
2. Overactive bladder
3. Overflow incontinence
4. Continue incontinence
STRESS INCONTINENCE

Stress incontinence is the involuntary loss of

uterine when the intravesical pressure exeeds the
maximum urethral closure pressure
in the obsence of detrusor activity
Etiologi Stress incontinence

Incompotenence of urethral closure mechanism

1. Components of urethral sphincter mechanism

2. Anatomic support of urethral and

the urethrovesical junction
 Sphincter urethra eksterna
(rhabdosphincter)
Otot peri-urethra dari
dasar panggul

Muara urethra
Kandung kemih Urethra
eksterna

Jaringan kolagen
Otot polos urethra dan
Otot detrusor jaringan ikat
 COMPONENTS OF THE
INTERNAL URETHRA
(Internal urethral sphincteric mechanism)

Urethral mucosa
The vascular content of the submucosal cavernous
plexus
Smooth muscle fibers in urethral wall
Elastic and connective tissue of the urethral wall
Rhabdosphincter (sphincter streated muscle)

Resting urethral closure pressure

ANATOMIC SUPPORT OF URETHRAL AND THE
URETHROVESICAL JUNCTION
(extrinsic urethral sphincteric mechanism)

Segment anterior vaginal wall

Pubocervical fascia, pubourethral ligaments
Pelvic diaphragm
Arcus tendineus fascia pelvis

Transmision pressure
Extrinsic Periuretral Pubourethral
sphincter striated ligament
mechanism muscle

Colagen
Intrinsic Urethral smooth muscle Bladder
sphincter Elastic tissue
mechanism rhabdosphincter Detrusor
 Transmision pressure

PELVIC FLOOR

A
 PELVIC FLOOR

B
DEFINITION
ICS
Overative detrusor or overactive bladder
one that is shown objectively to contract,
spontaneusly or on provocation during the
filling phase while the patient is
attempting to inhibit micturation (1976)
 2002 ICS TERMINOLOGY:
OVERACTIVE BLADDER

Overactive bladder (OAB) is a symptom syndrome

Urgency, with or without urge incontinence, usually with
frequency and nocturia
 these symptoms are suggestive of detrusor overactivity
(urodynamically demonstrable involuntary bladder
contractions) but can be due to other forms of voiding or urinary
dysfunction

 these terms can be used if there is no proven infection or other

obvious pathology

Abrams P et al. Neurourol Urodyn. 2002;21:167-178.

2002 ICS DEFINITIONS
Urgency is the complaint of a sudden compelling desire
to pass urine, which is difficult to defer

Increased daytime frequency is the complaint by the

patient that he/she voids too often by day (equivalent to
polyuria)

Nocturia is the complaint that the individual has to wake

at night 1 or more times to void

Abrams P et al. Neurourol Urodyn. 2002;21:167-178.

2002 ICS DEFINITIONS: INCONTINENCE

Urge urinary incontinence is the complaint of

involuntary leakage accompanied by or immediately
preceding urgency

Mixed urinary incontinence is the complaint of

involuntary leakage associated with urgency and also
with exertion, effort, sneezing, or coughing

Abrams P et al. Neurourol Urodyn. 2002;21:167-178.

ETIOLOGY OVERACTIVE BLADDER

1. Detrusor hyperreflexia or Neurogenic detrusor

overactivity

2. Detrusor instability or Idiopathic detrusor

overactivity
 IDIOPATIC

Neurotransmiter substance inhibitor

Cholinergic receptor
Adregenic receptor
Receptor Non Cholenergic Non adregenic
Others
TREATMENT OPTIONS

Conservative
Surgical/modulatory therapies
OVERACTIVE BLADDER TREATMENT

Conservative
Bladder training
Pharmacothrapy
PHARMACOLOGIC THERAPY

Oxybutynin
Tolterodine
Flavoxate Hydrochloride
Others
SURGICAL / MODULATORY THERAPIES

Denervation
 central
 peripheral and perivesical
Acupuncture
Electroacupunture
Electrical stimulation/neuromodulation
Overdistention
Augmentation cystoplasty
Inkontinensia urin kontinue
Kausa : fistula urogenitalis
Keluhan : keluar urine terus menerus dari vagina
akibat fistula
Penanganan : sesuai penanganan fistula
Inkontinensia overflow
Inkontinensia luapan
Diawali retensio urin
Kapasitas kandung kemih berlebihan
Sering terjadi post partum
Berlanjut  gangguan fungsi ginjal
Penanganan ~ retensio urin dan terhadap
komplikasinya
terimakasih