Mixed Urinary Incontinence: Pathogenesis and Clinical Findings



Urgency Urinary Incontinence (UUI) -> Urinary leakage preceded by a sudden, strong urge to void

  -> Overflow Incontinence -> Overfilling of the bladder from obstruction; BOO (tumour, stone, BPH, urethral or bladder neck stricture)

  -> Detrusor Overactivity -> OAB (idiopathic), CNS lesion (neurogenic), inflammation/ infection (cystitis, UTI), diabetes mellitus

  -> Bladder Wall Compliance -> 

Progressive increase in  intravesicle pressure during bladder filling pushing urine from the bladder



Stress Urinary Incontinence (SUI) -> Episodic involuntary urinary leakage with sudden increase in intra-abdominal pressure -> Urethral hypermobility, intrinsic sphincter deficiency, or a poorly coapting urethra -> Decreased Pelvic floor muscle and ligament strength causing Decreased tone of vesicoureteral sphincter unit; Decreased urethral strength and associated striated and smooth muscle; iatrogenic



 - Failure to Void - Weak Stream (+/- dribbling), Intermittent, Straining, Incr PVR if a complication of urinary retention; obstruction visible on cystoscopy

 - Failure to Store  - Frequency, Urgency, Nocturia, Dysuria if SUI or UUI not caused by obstruction

 - Urodynamic Studies - SUI — Decr urethral closure pressure with incr IAP/Bladder Volume and urinary leakage.  UUI— involuntary detrusor contraction and/or detrusor sphincter dyssynergia



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