Incontinencia urinaria de urgencia en mujeres adultas: ¿Qué tratamientos ofrecer en APS? / Emergency Urinary Incontinence in Adult Women: what treatments do we offer at PHC?

La incontinencia urinaria de urgencia corresponde a la pérdida involuntaria de orina, cuya causa es presumida multifactorial: hiperactividad del detrusor, hipersensibilidad vesical y distensibilidad reducida del detrusor. Esta patología es bastante frecuente tanto en Chile como en el mundo, con una prevalencia local entre 10% y 15%, a su vez genera un gran impacto en el bienestar físico, mental y socioeconómico del paciente. El diagnóstico es clínico, con apoyo en el uroanálisis y su tratamiento de primera línea puede ser realizado en APS. En cuanto al tratamiento existen tanto terapias no farmacológicas como farmacológicas; correspondiendo las técnicas de reentrenamiento vesical, los cambios de estilo de vida y los fármacos anticolinérgicos a tratamientos efectivos de primera línea. Existen, además, otros fármacos que pueden ser utilizados para el tratamiento de la IUU, cuya evidencia será igualmente revisada en este artículo.

Urge incontinence is defined as an involuntary leakage of urine, presumably with a multifactorial cause: detrusor overactivity, bladder hypersensibility and a reduced bladder compliance. It's a common disease worldwide, with local studies reporting a prevalence around 10-15%, causing a great impact in the physical, mental and socioeconomic well-being of the affected patients. Diagnosis is mainly based on the clinical history, supporting it with laboratory tests to rule out other conditions, and uncomplicated cases can be treated and followed in a primary care setting. There are pharmacologic and non-pharmacologic therapies, being healthy lifestyles changes, bladder retraining programs and anticholinergic drugs the first line of treatment. Additional pharmacologic treatments will be revised in this article.

O uso da eletroestimulação no nervo tibial posterior no tratamento da incontinência urinária / Electrostimulation of the posterior tibial nerve in treatment of urinary incontinence / Uso de la electroestimulación en el nervio tibial posterior en el tratamiento de la incontinencia urinaria

O objetivo deste estudo foi avaliar a eletroestimulação no nervo tibial posterior no tratamento da incontinência urinária de urgência ou mista. Trata-se de uma pesquisa quase experimental com oito pacientes, com diagnóstico de incontinência urinária de urgência ou mista, realizada no Estado de Santa Catarina, em 2010. A avaliação incluiu ficha de avaliação fisioterapêutica, diário miccional e questionário de qualidade de vida - King’s Health Questionnaire. Foram realizados 12 atendimentos de 30 minutos com eletroestimulação no nervo tibial posterior. Os resultados mostram redução na frequência de perdas urinárias diurnas em 62% das pacientes, diminuição da frequência miccional noturna em 37,5% e redução da quantidade das perdas urinárias, de intensa para moderada e de moderada para leve. Não se observou diferença significativa nos escores do questionário de qualidade de vida após o tratamento. Conclui-se que o método estudado apresentou impacto positivo nas pacientes em relação às perdas involuntárias de urina e à quantidade de urina perdida...

The aim of this study was to evaluate electrostimulation of the posterior tibial nerve in treating urgency or mixed urinary incontinence. This quasi-experimental study of eight patients with a diagnosis of urgency or mixed urinary incontinence, was conducted in Santa Catarina State, Brazil, in 2010. The assessment included a physical therapy evaluation form, bladder diary and King’s Health Quality of Life Questionnaire. Twelve 30-minutes procedures of electro-stimulation of the posterior tibial nerve were performed. The results show reduced frequency of daytime urinary incontinence in 62% of the patients, decreased nocturnal urinary frequency in 37.5%, and reduction of urinary leakage from severe to moderate and moderate to mild. No significant difference in quality of life questionnaire scores was observed after treatment. It was concluded that the method studied had positive impact on patients’ involuntary urine loss and the amount of urine lost...

El objetivo de este estudio fue evaluar la electroestimulación del nervio tibial posterior en el tratamiento de la incontinencia urinaria de urgencia o mixta. Se trata de una investigación casi experimental con ocho pacientes, con diagnóstico de incontinencia urinaria de urgencia o mixta, realizada en el Estado de Santa Catarina – Brasil, en 2010. La evaluación incluye ficha de evaluación fisioterapéutica, diario miccional y cuestionario de calidad de vida King’s Health Questionnaire. Se realizaron 12 atenciones de 30 minutos con electroestimulación del nervio tibial posterior. Los resultados muestran reducción en la frecuencia de pérdidas urinarias diurnas en 62% de las pacientes, disminución de la frecuencia miccional nocturna en 37,5% y reducción de la cantidad de orina de las pérdidas urinarias, de intensa a moderada y de moderada a leve. No se observó diferencia significativa en los resultados del cuestionario de calidad de vida después del tratamiento. Se concluye que el método estudiado presentó impacto positivo en las pacientes con relación a las pérdidas involuntarias de orina y a la cantidad de orina perdida...

[ relationship between stress, urge, and mixed urinary incontinence in females and urodynamic findings]

To investigate the relationship between clinical symptoms, severity of incontinence, and urodynamic findings in females suffering from mixed, urge and stress incontinence. One hundred and seventy three patients suffering from either urgency, urge incontinence, mixed or stress incontinence of those who were submitted to the urodynamic units in Aleppo University Hospitals between 1 January 2008 and 30 September 2009 were included in the study. Cystometric bladder capacity at maximal and first desire to void and bladder compliance, presence of overactivity or hypersensitivity, stress test according to the criteria of the International Continence Society were evaluated. The urodynamic study had a low sensitivity [54.5%,] and a high specificity [97.7%] in detecting genuine stress incontinence in women suffering from pure stress or mixed incontinence, and this sensitivity rose up to [87.5%] in women suffering from pure stress or stress-predominant mixed urinary incontinence. According to the parameters used in the study to put a diagnosis of urge incontinence on urodynamic study, the urodynamic study had a sensitivity of [87.7%] and a specificity of [90%] in detecting urge incontinence in women suffering from urinary pure urge or mixed incontinence. Some factors were statistically more common in the group of patients who had severe incontinence, and those factors were; old age, menopause, presence of urge incontinence in clinical history, presence of urge incontinence on urodynamic study, and presence of terminal overactivity on urodynamics. Subjective symptoms of urge and stress incontinence had good correlation with urodynamic findings in pure cases, and fair correlation in mixed cases. Severe incontinence correlated with a clinical history of urge and mixed incontinence