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Stephan L. Werner, MD FACS
With minor variations the evaluation of all forms of incontinence are similar. History The physician will inquire into the patient's symptoms, past urological and gynecological history, prior surgeries, medical conditions such as diabetes or stroke or other nervous system diseases or conditions, and medications being taken. Physical Examination is then performed, frequently with special attention to the pelvic examination, and evaluation of the nerve function of the pelvis and lower extremities. However some physicians may defer parts of this to the time of the urologic evaluation. Urological Evaluation varies greatly between practitioners patterns and is partially dependant upon the patient's condition. All the tests below are not needed for every patient, indeed some patients with simple stress incontinence need little more than a good physical examination, with a pelvic exam, a cystometrogram and cystoscopy, ( which might be done at the time of surgical repair). Other patients with more complex problems may need much more extensive evaluations. Pelvic Examination is done to see if the bladder and or the rectum and or the cervix are normal or whether they have "fallen". It is also important to know if the uterus is healthy or not as, on occasion, a hysterectomy is needed to get a good repair. A rectal examination is frequently done to evaluate the rectum. At the same time perineal, (bottom), sensation and reflexes may be examined. A Miller test, where a small q-tip is inserted into the urethra, and the patient asked to cough or strain, may help determine if the bladder and urethra is fallen. A Marshall test, where the bladder is filled, the patient asked to cough, and if stress incontinence is present the urologist will insert two fingers into the vagina, and support the bladder. The patient will again be asked to cough to see if urethral suspension will alleviate the leakage. is done to see if the bladder and or the rectum and or the cervix are normal or whether they have "fallen". It is also important to know if the uterus is healthy or not as, on occasion, a hysterectomy is needed to get a good repair. A rectal examination is frequently done to evaluate the rectum. At the same time perineal, (bottom), sensation and reflexes may be examined. A Miller test, where a small q-tip is inserted into the urethra, and the patient asked to cough or strain, may help determine if the bladder and urethra is fallen. A Marshall test, where the bladder is filled, the patient asked to cough, and if stress incontinence is present the urologist will insert two fingers into the vagina, and support the bladder. The patient will again be asked to cough to see if urethral suspension will alleviate the leakage. Urodynamics is a broad series of tests used to evaluate the physical structure and nerve function of the bladder and pelvic muscles and nerves. Most are not needed on most patients. The cystometrogram, (CMG), is a test of bladder and nerve function. that is usually done. It is extremely valuable in the evaluation and differentiation of stress, urge and mixed incontinence. A small catheter is passed into the bladder and the bladder filled with carbon dioxide. It gives information of the size, flexibility, sensitivity of the bladder. It may detect unsuspected hyper activity of the bladder, which may play a role in incontinence and may affect the results of surgery or other treatments. It is sometimes done both lying down and standing, to detect othostatic instability, the "as soon as I stand up I have to run" syndrome. This test has many variations including an electromyogram of the pelvic muscles to evaluate their function, and abdominal pressures to evaluate the effect of movement or straining on the CMG. Leak point pressures and urethral pressure profiles are simple tests to evaluate the function of the sphincter muscles. Voiding cystourethrograms where the bladder is filled with a contrast media that shows up on x-ray and either several films or a video of the x-ray are taken to evaluate the functional changes in the pelvic structures during voiding. These may be especially helpful in patients who have had prior surgeries for incontinence, or where a leak is suspected between the urinary tract and the vagina. Cystoscopy is a test where the urethra is anesthetized with a local anesthetic jelly, and a small telescope placed into the bladder to evaluate the anatomy. Treatment of Stress Incontinence click here
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[Home] Werner - Francis Urology Associates llc - Mid Atlantic Urology Associates llc Greenbelt - Bowie - Laurel Maryland (301) 441-8900 Fax (301) 982 0453 7500 Hanover Parkway Suite 206 Greenbelt, MD 20770
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