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Abstract

Urinary incontinence

Roughly 4 million women in Germany suffer from urinary incontinence. Due to genetic disposition and the increase in life expectancy, this number is expected to increase. Basic diagnostics (anamnesis, questionnaires, micturition protocol, exclusion of residual urine, urinary tract infections, and prolapse) allow the indication of conservative treatments (behavioural and pelvic floor training, medication, pessary treatment). Apart from the option of treating stress incontinence with Duloxetin, there has been rapid development in pharmacokinetic aspects of anticholinergic treatment of irritable bladder syndrome (M3 selective, transdermal application, foodstuff-independent resorption, circumvention of liver metabolism) and β3-sympathomimetic treatment (less side effects). Only when conservative treatment fails and when surgery is planned do further diagnostics become necessary (sonography, urodynamics and urethrocytoscopy). Operative therapy of stress incontinence dominates using tension-free polypropylene tapes; therapy resistant irritable bladder syndrome can be positively influenced by botox injections or sacral neuromodulation. Urinary incontinence is no longer a tabu, and about 90 % of patients can be treated successfully using modern diagnostics and treatments.

CME Prakt Fortbild Gynakol Geburtsmed Gynakol Endokrinol 2015; 11(2): 160–173

Keywords
Stress urinary incontinence, overactive bladder, anticholinergics, duloxetin, tension-free tapes

Ralf Tunn
Fachbereich Urogynäkologie, Deutsches Beckenbodenzentrum,
St. Hedwig Kliniken, Berlin
Reviewer: Heiko B. G. Franz, Braunschweig,
und Gülten Oskay-Özcelik, Berlin

Tunn R. Harninkontinenz Gynakol Geburtsmed Gynakol Endokrinol 2015; 11(2): 160–173 publiziert 31.07.2015 www.akademos.de/gyn ©akademos Wissenschaftsverlag 2015 ISSN 1614-8533