Kadında İdrar Kaçırma
Özet
Stres tipi idrar kaçırma (STİK), kadınlarda en sık görülen idrar kaçırma tipidir ve öksürme, hapşırma ya da fiziksel efor sırasında mesane içi basıncın üretral kapanma basıncını aşmasıyla gelişir. Prevalansı %15–35 arasında bildirilmektedir ve menopoz sonrası dönemde, vajinal doğum yapmış kadınlarda ve obez bireylerde daha sık rastlanır. Etiyolojide yaş, doğum sayısı, doğum şekli, hormonal değişiklikler, bağ dokusu ve nöromüsküler yapının zayıflaması öne çıkar. Patofizyolojik süreçte üretral hipermobilite, intrinsik sfinkter yetmezliği, pelvik taban kaslarının fonksiyonel yetersizlikleri, ligaman desteğinin azalması ve östrojen eksikliğine bağlı mukozal atrofi rol oynar. Ayrıca sinir hasarı ve kollajen metabolizmasındaki bozulmalar idrar tutma mekanizmalarını zayıflatır. Tanıda ilk basamak anamnez ve sorgu formlarıdır; alt üriner sistem semptomlarının derecesi ve yaşam kalitesine etkisi bu yöntemlerle değerlendirilir. Ped testi objektif doğrulama sağlar. Fizik muayene kapsamında stres testi, Q-tip testi ve Bonney manevrası üretral hipermobilite ve sfinkter yetmezliğini göstermede kullanılır. İdrar analizi ek patolojilerin dışlanmasına yardımcıdır. Ultrasonografi ile üretra ve mesane boynu dinamikleri incelenebilir. Ürodinamik çalışmalar, özellikle abdominal leak point pressure ölçümüyle sfinkter yetmezliği ve üretral hipermobiliteyi ayırt etmede değerli bilgiler sunar.
Referanslar
Abrams, P., Cardozo, L., Fall, M. Et al. The standardisation of terminology of lower urinary tract function: Report from the Standardisation Sub-committee of the International Continence Society. Neurourol. Urodyn. 2002, 21, 167–178.
Xunguo Yang, Xingqi Wang, Zhenhua Gao et al. The Anatomical Pathogenesis of Stress Urinary Incontinence in Women. Medicina (Kaunas). 2022;59:5.
De Vries, A.M., Venema, P.L., Heesakkers, J. Midurethral support is also necessary for reflex closure of the urethra. Neurourol. Urodyn. 2018; 37: 2965–2972.
Yang, C.C., Hokanson, J.A., Keast, J.R. Advancing our understanding of the neural control of the female human urethra. Neurourol. Urodyn. 2022; 41: 35–41.
Howard Atwood Kelly. The Examination of the Female Bladder and the Catheterization of the Ureters Under Direct Inspection,” Johns Hopkins Bulletin 4, 1893: 101-102.
Petros PE, Ulmsten UI. An integral theory of female urinary incontinence. Experimental and clinical considerations. Acta Obstet Gynecol Scand Suppl. 1990;153:7‐31.
DeLancey JO. Stress urinary incontinence: where are we now, where should we go? Am J Obstet Gynecol. 1996;175:311‐319.
Robinson BL, Geller EJ, Parnell BA et al. Diagnostic accuracy of visual urethral mobility exam versus Q-tip test: a randomized crossover trial. Am J Obstet Gynecol. 2012;206:528 e521-526.
Iva Miliˇci´c, Mislav Mikuš, Adam Vrbani´c and Držislav Kalafati´c. The Role of Gene Expression in Stress Urinary Incontinence: An Integrative Review of Evidence. Medicina (Kaunas)2023;59:700.
Medina CA, Costantini E, Petri E et al. Evaluation and surgery for stress urinary incontinence: A FIGO working group report. Neurourol Urodyn. 2017;36:518-528.
C.K. Harding (Chair), M.C. Lapitan (Vice-chair), S. Arlandis. Management of Non-Neurogenic Female Lower Urinary Tract Symptoms. EAU guidelines 2024; p:11-19.
Guralnick ML, Fritel X, Tarcan T, Espuna-Pons M, Rosier PFWM. ICS Educational Module: cough stress test in the evaluation of female urinary incontinence: introducing the ICS-Uniform Cough Stress Test. Neurourol Urodyn 2018;37:1849—55.
Espuña-Pons M, Dilla T, Castro D, Car-bonell C, Casariego J, Puig-Clota M. Analysis of the value of the ICIQ-UI SF questionnaire and stress test in the differential diagnosis of the type of urinary incontinence. Neurourol Urodyn. 2007;26:836-41.
F.S. Miyazaki, The Bonney test: a reassessment. Am J Obstet Gynecol,1997; 177:1322-1328.
Lında Cardozo, Erıc Rovner, Adrıan Wagg, Alan Weın, Paul Abrams. Committee 5 Urodynamic testing, Incontinence 2023:487-526.
Referanslar
Abrams, P., Cardozo, L., Fall, M. Et al. The standardisation of terminology of lower urinary tract function: Report from the Standardisation Sub-committee of the International Continence Society. Neurourol. Urodyn. 2002, 21, 167–178.
Xunguo Yang, Xingqi Wang, Zhenhua Gao et al. The Anatomical Pathogenesis of Stress Urinary Incontinence in Women. Medicina (Kaunas). 2022;59:5.
De Vries, A.M., Venema, P.L., Heesakkers, J. Midurethral support is also necessary for reflex closure of the urethra. Neurourol. Urodyn. 2018; 37: 2965–2972.
Yang, C.C., Hokanson, J.A., Keast, J.R. Advancing our understanding of the neural control of the female human urethra. Neurourol. Urodyn. 2022; 41: 35–41.
Howard Atwood Kelly. The Examination of the Female Bladder and the Catheterization of the Ureters Under Direct Inspection,” Johns Hopkins Bulletin 4, 1893: 101-102.
Petros PE, Ulmsten UI. An integral theory of female urinary incontinence. Experimental and clinical considerations. Acta Obstet Gynecol Scand Suppl. 1990;153:7‐31.
DeLancey JO. Stress urinary incontinence: where are we now, where should we go? Am J Obstet Gynecol. 1996;175:311‐319.
Robinson BL, Geller EJ, Parnell BA et al. Diagnostic accuracy of visual urethral mobility exam versus Q-tip test: a randomized crossover trial. Am J Obstet Gynecol. 2012;206:528 e521-526.
Iva Miliˇci´c, Mislav Mikuš, Adam Vrbani´c and Držislav Kalafati´c. The Role of Gene Expression in Stress Urinary Incontinence: An Integrative Review of Evidence. Medicina (Kaunas)2023;59:700.
Medina CA, Costantini E, Petri E et al. Evaluation and surgery for stress urinary incontinence: A FIGO working group report. Neurourol Urodyn. 2017;36:518-528.
C.K. Harding (Chair), M.C. Lapitan (Vice-chair), S. Arlandis. Management of Non-Neurogenic Female Lower Urinary Tract Symptoms. EAU guidelines 2024; p:11-19.
Guralnick ML, Fritel X, Tarcan T, Espuna-Pons M, Rosier PFWM. ICS Educational Module: cough stress test in the evaluation of female urinary incontinence: introducing the ICS-Uniform Cough Stress Test. Neurourol Urodyn 2018;37:1849—55.
Espuña-Pons M, Dilla T, Castro D, Car-bonell C, Casariego J, Puig-Clota M. Analysis of the value of the ICIQ-UI SF questionnaire and stress test in the differential diagnosis of the type of urinary incontinence. Neurourol Urodyn. 2007;26:836-41.
F.S. Miyazaki, The Bonney test: a reassessment. Am J Obstet Gynecol,1997; 177:1322-1328.
Lında Cardozo, Erıc Rovner, Adrıan Wagg, Alan Weın, Paul Abrams. Committee 5 Urodynamic testing, Incontinence 2023:487-526.
