What Is Urinary Leakage?

Urinary leakage refers to abnormal channels between the urinary system and other systems and organs. This disease is more common in women of childbearing age. The chance of urinary leakage due to dystocia is very low in developed countries, but it is still an important gynecological disease in developing countries. According to its clinical manifestations and medical history, combined with gynecological examination, it is found that the vagina has leaky urethral channels, and the diagnosis is not difficult.

Basic Information

Visiting department: Urology
Multiple groups: Women of childbearing age

Common causes: Gynecological injury, childbirth injury, pelvic fracture, rough sex, etc.
Common symptoms: Leaking urine, urinary eczema, menstrual disorders, depression, etc.

Causes of female urinary leakage

The common causes of urinary leakage in women are diverse, mainly due to the following factors:

Gynecological injury

Such as cervical cancer, retroperitoneal tumors and other operations may cause bladder, ureter damage and urine leakage.

2. Birth injury

Such as fetal incarceration in the middle pelvis, can cause bladder vaginal fistula or bladder urethral vaginal fistula. If the fetal stagnation stays at the pelvic outlet for too long, urethral vaginal fistula and vaginal ring scarring will occur.

3. Trauma

Such as pelvic fractures, rough sex and so on.

4. Urinary deformities

Such as congenital ectopic openings.

5. Other

Advanced bladder tuberculosis, pelvic tumors, etc.

Clinical manifestations of urinary leakage in women

Leak urine

That is, urine continues to flow out through the vagina, unilateral ureteral vaginal fistula, still voluntarily urinate, and the bladder vaginal fistula with large fistula can not urinate automatically. Urinary vaginal fistula only has urine flowing out through the vagina during urination.

2. Urinary eczema

Long-term irritation of the urine causes the perineum and perianal skin to become red, swollen, and thickened, sometimes with pimples or superficial ulcers, itching and burning of the vulva.

3. Menstrual disorders

10% to 15% of patients with long-term amenorrhea or reduced menstruation.

4. Depression

Due to long-term urine dripping, soiling of clothes and pants, overflowing urine odor, it is difficult to live with people. At night, the mattresses are wet and sexually disturbed, so they are depressed or even bored.

5. Other

Generally have a history of delayed labor, difficult labor or gynecological surgery.

Female urine leak check

Cystoscopy

You can understand the number, size, and location of fistulas, the relationship between fistulas and ureteral orifices, urethral orifices, and understand the bladder volume, whether inflammation, stones, diverticulum, etc.

2. Methylene blue test

Can identify bladder vaginal fistula or ureteral vaginal fistula.

3.Indigo carmine test

The operation procedure was intravenous injection of indigo carmine 5 ml, and it was judged whether the blue liquid overflowed from the fistula after 5-7 minutes. If there is a fistula. Applicable to the diagnosis of congenital ureteral ectopic or ureteral fistula.

4. Intravenous urography

Intravenous urography (IVP) is an inspection method that uses the intravenous injection of contrast agents to make the kidneys, ureters, and bladder develop for diagnosis. It is a commonly used inspection method in urology and gynecology. It is characterized by less pain and high diagnostic efficiency. In particular, it has authoritative diagnostic purposes for urinary stones and urinary excretion. Can understand the situation of the upper urinary tract, determine the position of ureteral fistula and renal function.

5.Urodynamic tests

Female urine leak diagnosis

Diagnosis based on clinical manifestations and related examinations.

Differential diagnosis of urine leakage in women

The disease should be distinguished from the following:

Ectopic opening of ureter

Mostly associated with double kidney and double ureter malformations. In addition to normal urination, continuous drip leakage or spitting of urine was seen in the vagina, vestibule, urethral orifice, etc. This leakage was not related to increased abdominal pressure. IVU shows the affected kidney and double ureter, and the upper kidney often has hydronephrosis or hypoplasia.

2. Stress urinary incontinence

Urine inadvertently leaks from the urethral opening when coughing, laughing, sneezing, or carrying heavy objects. When the degree of urinary incontinence is severe, that is, when urine overflows while walking, standing and lying, it is necessary to identify the urine leakage. When examining patients with stress urinary incontinence, no fistula can be found. Increased abdominal pressure when the bladder is full and urine flows out of the urethral opening; however, when the index and middle fingers are inserted into the vagina and the urethra is lifted up on both sides of the bladder neck, the urinary flow can be stopped and no urine leaks from the vaginal opening. If there is still urine leaking from the vaginal opening, it is a urine leak.

3. Overflow urinary incontinence

Due to dysfunction of the bladder neck sphincter and internal urethral sphincter, urine continuously drips from the urethral orifice, and the patient does not feel urination. The bladder is always empty. Patients with this type of urinary incontinence can not find fistula inside the vagina, no vaginal leakage after compression of the urethra.

4. True urinary incontinence

No urine can be stored in the bladder, and the patient's urine will flow out of the urethra while standing. Patients with this type of urinary incontinence may find sphincter laxity when examined, but they may not find an intravaginal fistula.

5. Tuberculous bladder spasm

During the healing process of bladder tuberculosis, the bladder contracts, and the bladder volume can be less than 50 ml. Symptoms of frequent urination and urinary incontinence occur due to inability to store urine effectively. Imaging studies often show typical changes in renal tuberculosis and hydronephrosis in the kidney and ureter. When fluid is injected into the bladder, the volume of fluid is only a few tens of milliliters, and the patient experiences pain or the fluid is forced to flow out of the urethral orifice.

Urinary Leakage Treatment for Women

Currently, drainage methods are still used, but no matter what type of bladder drainage is used, the drainage tube must be kept unobstructed.

There is generally no need to flush the bladder during the indwelling catheter. If there is a lot of hematuria or sediment and the urinary tube is blocked, you can use a small amount (10-20 ml each time) of sterile physiological saline or sterilized 1: 5000 furacicillin solution to rinse it at low pressure until it is unobstructed.