Začetna obravnava bolnice z motnjami v delovanju medeničnega dna
DOI:
https://doi.org/10.6016/ZdravVestn.2632Ključne besede:
motnje v funkciji medeničnega dna, urinska inkontinenca, uroginekologija, zdrs medeničnih organovPovzetek
Uroginekologija se ukvarja z diagnosticiranjem in zdravljenjem motenj v funkciji medeničnega dna. Gre za pogost pojav, s katerim se srečuje vsaj polovica vseh žensk. Simptomi, ki kažejo na disfunkcijo medeničnega dna, so številni. Najpogosteje pa se srečujemo s tistimi, ki jih povzročata urinska inkontinenca in zdrs medeničnih organov (ZMO).
Začetna obravnava bolnice z motnjami v funkciji medeničnega dna zajema uroginekološko anamnezo z analizo dnevnika uriniranja, analizo urina ter klinični pregled. Cilj usmerjene uroginekološke anamneze je opredelitev bolničinih glavnih simptomov, njihovega trajanja, značilnosti in vpliva na bolničino kakovost življenja. Nadalje bolnico povprašamo o jakosti teh simptomov, sprožilnih dejavnikih in njihovem začetku. Pomembno je opredeliti količino in vrsto tekočine, ki jo bolnica zaužije čez dan. Prav tako pridobimo celotno ginekološko anamnezo, podatke o spremljajočih boleznih, operacijah in možnih alergijah. Skupaj z anamnezo lahko analiziramo tudi dnevnik uriniranja, ki nam poda pomembne podatke glede frekvence, inkontinenčih epizod, uporabe vložkov, vnosa tekočin in stopnje urgence ter inkontinence v določenem obdobju.
Anamnezi sledi klinični pregled, ki je sestavljen iz splošnega statusa, pregleda trebuha in vaginalnega pregleda z oceno stopnje ZMO ter moči mišic medeničnega dna (MMD). Priporočamo, da se za oceno ZMO uporablja Pelvic Organ Prolapse Quantification System (sistem POP-Q) in da se moč MMD ocenjuje z digitalno palpacijo, pri čemer se za opredelitev moči krčenja uporablja bodisi šeststopenjsko oxfordsko lestvico bodisi štiristopenjsko lestvico moči MMD. Zaradi visoke prevalence okužb sečil pri ženskah s simptomi v spodnjih sečilih sta nepogrešljiv del obravnave teh bolnic tudi analiza urina in urinokultura.
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Literatura
Chittacharoen A. How to approach common urogynaecological problems? J Med Assoc Thai. 2005 Oct;88 Suppl 2:S124–8. PMID:17722326
Jeffery S, de Jong P. (ur). Textbook of urogynaecology. South Africa: University of Cape Town; 2010.
Abrams P, Andersson KE, Birder L, Brubaker L, Cardozo L, Chapple C, et al.; Members of Committees; Fourth International Consultation on Incontinence. Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn. 2010;29(1):213–40. https://doi.org/10.1002/nau.20870 PMID:20025020
Milsom I. (ur). Epidemiology of Urinary Incontinence (UI) and other Lower Urinary Tract Symptoms (LUTS), Pelvic Organ Prolapse (POP) and Anal Incontinence (AI). V: Abrams P, Cardozo L, Khoury S, Wein A. Incontinence. Peta izdaja. ICUD-EAU. Pariz; 2013.
Bohlin KS, Ankardal M, Nüssler E, Lindkvist H, Milsom I. Factors influencing the outcome of surgery for pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2018 Jan;29(1):81–9. https://doi.org/10.1007/s00192-017-3446-9 PMID:28894904
Vergeldt TF, Weemhoff M, IntHout J, Kluivers KB. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J Pelvic Floor Dysfunct. 2015 Nov;26(11):1559–73. https://doi.org/10.1007/s00192-015-2695-8 PMID:25966804
But I, Palfy M, Glodež S. Urinary incontinence and overactive bladder in patients attending the family practice physicians office: a pan-Slovenian cross-sectional, questionnaire-based survey. Zdrav Vestn. 2013;82:225–33.
Roškar AM. Samopodoba ženske z urinsko inkontinenco [diplomsko delo]. Maribor, Univerza v Mariboru; 2017.
Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al.; International Urogynecological Association; International Continence Society. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20. PMID:19941278
National Institute for Health and Care Excellence. Urinary incontinence in women: management. Clinical guideline. Dostopno 1. septembra 2016 na: https://www.nice.org.uk/guidance/cg171
Staskin D, Kelleher D. (ur). Initial assessment of urinary incontinence in adult male and female patients. V: Abrams P, Cardozo L, Khoury S, Wein A. Incontinence. Peta izdaja. ICUD-EAU. Pariz; 2013.
Kölle D, Windisch J, Kropshifer S, Marth C. Evaluation of urinary incontinence and prolapse. V: Lukanovič A, Tamussino K. Urogynecology today. Portorož: Slovene Urogynecological Society and Austrian Society for Urogynecology and Pelvic Reconstructive Surgery; 2004.
Staskin D, Kelleher D. (ur). Patient-reported outcome assessment. V: Abrams P, Cardozo L, Khoury S, Wein A. Incontinence. Peta izdaja. ICUD-EAU. Pariz; 2013.
Farrell SA, Epp A, Flood C, Lajoie F, MacMillan B, Mainprize T, et al.; Urogynaecology Committtee; Executive and Council of the Society of Obstetricians and Gynaecologists of Canada. The evaluation of stress incontinence prior to primary surgery. J Obstet Gynaecol Can. 2003 Apr;25(4):313–24. https://doi.org/10.1016/S1701-2163(16)31034-9 PMID:12679823
Peschers UM, Gingelmaier A, Jundt K, Leib B, Dimpfl T. Evaluation of pelvic floor muscle strength using four different techniques. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(1):27–30. https://doi.org/10.1007/s001920170090 PMID:11294527
Persu C, Chapple CR, Cauni V, Gutue S, Geavlete P. Pelvic Organ Prolapse Quantification System (POP-Q) - a new era in pelvic prolapse staging. J Med Life. 2011 Jan-Mar;4(1):75–81. PMID:21505577
Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996 Jul;175(1):10–7. https://doi.org/10.1016/S0002-9378(96)70243-0PMID:8694033
Hall AF, Theofrastous JP, Cundiff GW, Harris RL, Hamilton LF, Swift SE, et al. Interobserver and intraobserver reliability of the proposed International Continence Society, Society of Gynecologic Surgeons, and American Urogynecologic Society pelvic organ prolapse classification system. Am J Obstet Gynecol. 1996 Dec;175(6):1467–70. https://doi.org/10.1016/S0002-9378(96)70091-1 PMID:8987926
Rosier PF. (ur). Urodynamic testing. V: Abrams P, Cardozo L, Khoury S, Wein A. Incontinence. Peta izdaja. ICUD-EAU. Pariz; 2013.
Mattison ME, Simsiman AJ, Menefee SA. Can urethral mobility be assessed using the pelvic organ prolapse quantification system? An analysis of the correlation between point Aa and Q-tip angle in varying stages of prolapse. Urology. 2006 Nov;68(5):1005–8. https://doi.org/10.1016/j.urology.2006.05.030 PMID:17095054
Kim SO, Chung HS, Hwang EC, Oh KJ, Kwon D. Point Aa of the POP-Q system as a predictive value of urethral mobility in women. Int Urogynecol J Pelvic Floor Dysfunct. 2011 Jun;22(6):687–91. https://doi.org/10.1007/s00192-010-1316-9 PMID:21104403
Salvatore S, Serati M, Uccella S, Koelbl H, Artibani W, Cardozo L, et al. Inter-observer reliability of three different methods of measuring urethrovesical mobility. Int Urogynecol J Pelvic Floor Dysfunct. 2008 Nov;19(11):1513–7. https://doi.org/10.1007/s00192-008-0671-2PMID:18604464
Latini JM, Zimmerman MB, Kreder KJ Jr. Association between valsalva and cough leak point pressures and pelvic organ prolapse quantification in women with stress incontinence. J Urol. 2005 Apr;173(4):1219–22. https://doi.org/10.1097/01.ju.0000152323.78869.93PMID:15758756
Pollak JT, Jenkins P, Kopka SL, Davila GW. Effect of genital prolapse on assessment of bladder neck mobility by the Q-tip test. Obstet Gynecol. 2003 Apr;101(4):662–5. PMID:12681867
Crystle CD, Charme LS, Copeland WE. Q-tip test in stress urinary incontinence. Obstet Gynecol. 1971 Aug;38(2):313–5. PMID:5105346
Noblett K, Lane FL, Driskill CS. Does pelvic organ prolapse quantification exam predict urethral mobility in stages 0 and I prolapse? Int Urogynecol J Pelvic Floor Dysfunct. 2005 Jul-Aug;16(4):268–71. https://doi.org/10.1007/s00192-005-1315-4 PMID:15856131
Zyczynski HM, Lloyd LK, Kenton K, Menefee S, Boreham M, Stoddard AM; Urinary Incontinence Treatment Network (UITN). Correlation of Q-tip values and point Aa in stress-incontinent women. Obstet Gynecol. 2007 Jul;110(1):39–43. https://doi.org/10.1097/01.AOG.0000267190.09976.81 PMID:17601894
Larrieux JR, Balgobin S. Effect of anatomic urethral length on the correlation between the Q-tip test and descent at point Aa of the POP-Q system. Int Urogynecol J Pelvic Floor Dysfunct. 2008 Feb;19(2):273–6. https://doi.org/10.1007/s00192-007-0429-2 PMID:17687500
Cogan SL, Weber AM, Hammel JP. Is urethral mobility really being assessed by the pelvic organ prolapse quantification (POP-Q) system? Obstet Gynecol. 2002 Mar;99(3):473–6. PMID:11864676
Robinson BL, Geller EJ, Parnell BA, Crane AK, Jannelli ML, Wells EC, et al. Diagnostic accuracy of visual urethral mobility exam versus Q-Tip test: a randomized crossover trial. Am J Obstet Gynecol. 2012 Jun;206(6):528.e1–6. https://doi.org/10.1016/j.ajog.2012.02.015PMID:22459346
Rosencrantz M, Menefee SA, Lukacz ES. The correlation of urethral mobility and point Aa of the pelvic organ prolapse quantification system before and after surgery. Am J Obstet Gynecol. 2006 Dec;195(6):1841–5. https://doi.org/10.1016/j.ajog.2006.06.064 PMID:17014817
Tapp K, Connolly A, Visco AG. Evaluation of Aa point and cotton-tipped swab test as predictors of urodynamic stress incontinence. Obstet Gynecol. 2005 Jan;105(1):115–9. https://doi.org/10.1097/01.AOG.0000146642.68543.69 PMID:15625151
Serdinšek T, But I. Anterior compartment descent: A new measure in the assessment of urethral hypermobility in women with urinary incontinence. Int J Urol. 2017 Jul;24(7):548–52. https://doi.org/10.1111/iju.13370 PMID:28556438
Tubaro A. (ur). Imaging, Neurophysiological Testing and Other Tests. V: Abrams P, Cardozo L, Khoury S, Wein A. Incontinence. Peta izdaja. ICUD-EAU. Pariz; 2013.
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