Continuous Urinary Incontinence

Editor: Elisabetta Costantini, Ester Illiano
Last updated August 2018

Current Defintion

Continuous urinary incontinence (CUI) is the complaint of continuous involuntary loss of urine (1)

History

Continuous urinary incontinence (CUI) is the complaint of continuous leakage (2) Uncategorised incontinence: is the observation of involuntary leakage that cannot be classified into one of the categories (stress or urgency incontinence) on the basis of signs and symptoms (2)

Controversy

Sometimes it can also represent an altered perception of urinary incontinence: for example the patient is not able to separate the time of leakage from dry periods, when incontinence is severe and leakages occur “all the time”. In fact they may be unable to contextualize the leakage in stress, urgency or special situations. In other cases the patient is not able to determine the type of leakage . In fact she thinks the wetness she feels is urine when in fact it is sweating or vaginal discharge.

A careful medical and urogynecologic history and examination may be useful (obstetric trauma, pelvic surgery, radiation therapy, type of leakage). Without iatrogenic or functional causes a dye test can be helpful to verify if the leakage represents urine versus another fluid such as vaginal discharge.

Classification on the basis of the causes: • Iatrogenic or cancer causes (Urogenital fistula) • Congenital causes (Ectopic ureter) • Functional causes (Intrinsic sphincter deficiency (ISD) Classification on the basis of the site of the leakage: • Extra urethral incontinence: is defined as the observation of urine leakage through channels other than the urethral meatus, for example, fistula (1) • Urethral incontinence: is defined as the observation of urine leakage through the urethra. In literature there is the case of a 9-year-old female presented continuous incontinence after incision of the obstructed hemivagina. Really she had a rare Müllerian duct abnormality with obstructed hemivagina, ipsilateral renal anomaly (OHVIRA).(3) Classically, this presents after menarche with severe dysmenorrhea and a pelvic mass due to hematocolpo; but in this case diagnosis was further delayed due to the presence of continuous incontinence, which is not typical of this syndrome.

In an other case a 66-year-old woman suffered from severe stress incontinence which had gradually developed into continuous urinary incontinence. Videourodynamic studies at the first presentation demonstrated an acontractile detrusor without bladder sensation (bladder sensation at first desire to void >600 mL) in cystometry and no activity in the externalsphincter electromyography with a needle electrode. After the surgery, she was continent but could not void as had beenexpected. Only three years later was diagnosed a multiple system atrophy.(4)

Both cases show that continuous urinary incontinence should not be underestimated, it must always be seen as the symptom of something that could be even more serious than incontinence itself. A careful history, clinical examination and a rational use of instrumental examinations could help to find out what is behind a simple loss of urine!!

References

  1. Bernard T. Haylen, Dirk de Ridder, Robert M. Freeman; An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Floor Dysfunction Neurourology and Urodynamics 29:4–20 (2010)

  2. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A; The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002;21(2):167-78.

3.Saltzman A,C.C. rotha Curious Case of Continuous Incontinence Urology Volume 92, June 2016, Pages 113-116

  1. Mashidori T, Yamanishi T, Yoshida K, Continuous urinary incontinence presenting as the initial symptoms demonstrating acontractile detrusor and intrinsic sphincter deficiency in multiple system atrophy.Int J Urol. 2007 Oct;14(10):972-4.
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