Tham khảo tài liệu 'tình huống sản khoa - tình huống 2', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | s I I I II Clinical Cases CASE 1 A 48-ycar-old CỈ3 P3 woman complains of a 2-year history of loss of urine four to five times each day typically occurring 2 to 3 sec after coughing sneezing or lifting additionally she notes dysuria and the urge to void during these episodes. These events cause her embarrassment and interfere with her daily activities. The patient is otherwise in good health. A urine culture performed 1 month previously was negative. On examination she is slightly obese. Her blood pressure is 130 80 her heart rate is 80 beats per min and her temperature 99 F. The breast examination is normal without masses. Her heart has a regular rate and rhythm without murmurs. The abdominal examination reveals no masses or tenderness. A midstream voided urinalysis is unremarkable. What is your next step What is the most likely diagnosis What is the best initial treatment 31 c SI I Ills OBSTETRICS AND GYNECOLOGY ANSWERS TO CASE 1 Urinary Incontinence Sumiììíirv A 4X-year-old multiparous woman complains of urinary incontinence which is possibly related to stress activities. There is a prominent urge component and a delay from the Valsalva maneuver to the loss of urine. Next step Evaluate the urinary incontinence including a cystometric examination to discern the etiology. Most likely diagnosis Mixed genuine stress and urge incontinence. Best initial treatment Anticholinergic medication to treat the urge symptoms and then reassess the symptoms. Analysis Objectives 1. Discern between the typical history of genuine stress urinary incontinence CjSUI versus urge urinary incontinence UU1 . 2. Know that the cystometric examination can be used to distinguish between the two etiologies. 3. Know the treatments for both entities GSU1 and UUI . Considerations This patient s history does not offer a straightforward etiology for her urinary incontinence. In particular genuine SU1 cannot be diagnosed since there is an urge component as well as a several second delay from cough to
