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Incontinence
When most clinicians first see the term near infrared spectroscopy (NIRS), they do not recognize that this is an application of physics to medicine that they do in fact have some experience using. Transillumination of a scrotal mass employs the basic physics of light transmission through tissue, and oximetry is able to provide measurement of oxygen saturation (SaO2) because of application of spectroscopic principles. Oximeters use wavelengths that optimize light penetration into tissue and allow measurement of changes in the concentration of hemoglobin because light absorption by this molecule varies depending on the wavelengths used and whether or not it is carrying oxygen. The net result, derived with the aid of signal averaging and software algorithms, is a value of such importance that it is now widely regarded as “the fifth vital sign.”
The International Continence Society (ICS) defines urinary incontinence as the complaint of any involuntary leakage.1 The prevalence of urinary incontinence in community-dwelling women ranges from 10% to 40%; wider ranges can be found in elderly women.2 In studies that differentiate any urinary incontinence from severe or daily disease, the prevalence was 29% (range 11%–72%) and 7% (3%–17%), respectively.3 About a quarter of urinary incontinence is regarded as severe.4 Prevalence has always been higher in institutionalized subjects. Several recent studies from around the world suggest a prevalence of ≥ 50%.2 Approximately half of all incontinent women are classified as stress incontinent, making this group the largest among urge, mixed, and stress types.3
Physicians and their patients have been well served by the recent innovations that have revolutionized the treatment of urinary incontinence and pelvic surgery; however, few developments have dramatically improved post-operative (post-op) urinary management since the introduction of the Foley catheter in 1935.1 There is scarcely better support for this position than the prevalence of cases in which the patients’ predominant concerns are directed toward post-op care rather than the comparative risks inherent to surgical intervention.
Ironically, apprehension regarding postsurgical catheters and urine bags typically overshadows what would logically be far more serious mortality and morbidity concerns associated with general anesthesia, significant blood loss, or other surgical complications.2,3
Urinary incontinence is the involuntary loss of urine. In the United States it may affect 13 million people, with an economic cost of more than 20 billion dollars. 1 With the aging population, the number of people and funds spent on managing incontinence will likely continue to grow.
The cause of urinary incontinence can be very simply viewed as an abnormaility in either bladder function, sphincter function, or a combination of the two. Bladder abnormalities that can lead to urinary incontinence include poor bladder compliance and detrusor overactivity. Urinary incontinence due to sphincteric dysfunction is generally associated with previous prostate surgery, trauma, or neurologic disease. The workup begins with good history-taking and a physical exam, including rectal and neurologic exams. Pressure-flow studies and multichannel urodynamics with or without flouroscopy are often useful in determining the cause of incontinence. Cystoscopy is also helpful to rule out any urethral or bladder-neck abnormalities. Lab studies may include urinalysis and serum creatine measurement.
About 5% of the population suffers from urinary incontinence, and the proportion is much higher among the elderly. This means that in a city region of 2 million people there are about 100,000 people with this problem— probably about 100 new cases every week (figure 1,). Most of these people receive no help because it is not offered and they do not ask for it, although half of them would like it.
Incontinence in a child can be a diffi cult problem for child, parent, and physician. A comprehensive history and physical examination will often narrow down the cause of the problem and lead to the development of a treatment plan; however, sometimes more extensive testing is needed because incontinence may be multi-factorial. Often the treatment strategy needs to be similarly multi-modal.
