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Abstract
Objectives. To present an overview of current knowledge regarding the epidemiology, pathophysiology,
and evaluation of urinary incontinence (UI) with a focus on the problem of the overactive
bladder.
Methods. The most recent data on the epidemiology of UI are presented. The literature on the
pathophysiology of urinary urge incontinence (UUI) is reviewed, and key concepts related
to patient evaluation are summarized.
Results. The prevalence of UI depends on the population being surveyed. The overactive bladder
constitutes a substantial percentage of the overall problem, ranging from >50% of
incontinent men to only 10% to 15% of incontinent younger women. Few data are available
on the incidence of the disorder or on racial/ethnic trends. Overactive bladder or
urge incontinence is called detrusor hyperreflexia when a neurologic cause is known
and detrusor instability when there is no neurologic abnormality. Although the pathophysiology
of idiopathic instability is not well understood, some evidence suggests that this
condition may result from subclinical neurologic disease or primary smooth muscle
disease. Most patients with UUI can be adequately evaluated with a history, physical
examination, determination of postvoid residual volume, and urinalysis. When neurologic
disease or other complicating factors are present, or if initial treatment fails,
sophisticated urodynamic testing is appropriate.
Conclusions. Urinary incontinence is prevalent in all strata of the population, although it affects
women and the elderly disproportionately. With the exception of cases in which a neurologic
lesion can be demonstrated. the etiology of UUI remains elusive. A thorough history,
physical examination, determination of postvoid residual, and urinalysis will be adequate
to classify and treat the majority of patients.
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© 1998 Published by Elsevier Inc.