Virtsankarkailu (naiset)
Käypä hoito -suositus |  Julkaistu: 2017-09-05   | Tila: voimassa  |  Aihepiiri(t): Geriatria, Kuntoutus, Naistentaudit ja synnytykset, Neurologia, Urologia, Yleislääketiede
Mikä on Käypä hoito -suositus?
Suomalaisen Lääkäriseuran Duodecimin ja Suomen Gynekologiyhdistyksen asettama työryhmä
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Virtsankarkailu (naiset)

Käypä hoito
5.9.2017
Suomalaisen Lääkäriseuran Duodecimin ja Suomen Gynekologiyhdistyksen asettama työryhmä

Opi ja ota käyttöön

Koosteet

 

Miten viitata Käypä hoito -suositukseen? «»1

Keskeinen sisältö

  • Virtsankarkailun tyyppi (ponnistus-, pakko- ja sekamuotoinen) määritetään anamneesilla, kyselykaavakkeilla, yleisellä ja gynekologisella tutkimuksella yskäisytestineen.
  • Painonhallinta, tupakoimattomuus, lantionpohjan lihaskunnon ylläpito, ummetuksen hoito ja erityisesti 65 vuotta täyttäneillä fyysinen aktiivisuus ehkäisevät virtsankarkailua.
  • Lantionpohjan ohjattua fysioterapiaa käytetään lievän ja keskivaikean ponnistusvirtsankarkailun hoidossa. Lihasvoimaa voi kasvattaa harjoittelemalla 5 kertaa viikossa ja ylläpitää harjoittelemalla pysyvästi 2–3 kertaa viikossa.
  • Vaikeaan ponnistusvirtsankarkailuun on tehokas, vähän kajoava leikkaushoito, jota käytetään myös osalla sekamuotoisesta virtsankarkailusta kärsivistä potilaista.
  • Emättimeen annosteltava paikallinen estrogeenihoito lievittää pakkovirtsankarkailun oireita vaihdevuosi-iän saavuttaneilla naisilla.
  • Pakkovirtsankarkailua voidaan lievittää elintapamuutoksilla ja lääkkeillä.
  • Pakkovirtsankarkailun lääkehoidon teho arvioidaan aluksi 1–3 kuukauden kuluessa ja sen jälkeen vuosittain sekä aina, kun oireet uusiutuvat. Tarvittaessa lääkitys tulee vaihtaa.
  • Iäkkäillä, haurailla ja monisairailla antikolinergien haitat saattavat olla erityisen hankalia, eikä oksibutyniiniä tulisi keskushermostohaittojensa vuoksi käyttää heillä lainkaan. Lisäksi tulee muistaa ylivuotovirtsankarkailun mahdollisuus.

Tavoite

  • Tavoitteena on yhtenäistää naisten virtsankarkailun eli virtsainkontinenssin tutkimus- ja hoitokäytäntöjä avoterveydenhuollossa ja erikoissairaanhoidossa.

Kohderyhmä

  • Suosituksen kohderyhmänä ovat avoterveydenhuollon ja erikoissairaanhoidon lääkärit ja muu hoitohenkilökunta, kotihoito ja vanhusten hoitolaitosten henkilöstö sekä terveydenhuollon päätöksentekijät.

Määritelmä ja aiheen rajaus

Taulukko 1. Naisen virtsankarkailun tyypit ja syntymekanismit «Hilton P, Dolan LM. Pathophysiology of urinary incontinence and pelvic organ prolapse. BJOG 2004;111 Suppl 1:5-9 »3, «Mostwin J, Bourcier A, Haab F ym. Pathophysiology of urinary incontinence, fecal incontinence and pelvic organ prolapse. Kirjassa: Abrams P, Cardozo L, Khoury S, Wein A (toim.). Incontinence. Health P»4
Virtsankarkailun tyyppi Syntymekanismi Mahdollisia aiheuttajia
Ponnistusvirtsankarkailu eli virtsan karkaaminen fyysisen rasituksen tai ponnistuksen (esim. yskäisy tai aivastus) yhteydessä Virtsaputkea ympäröivien tukirakenteiden tai virtsaputken sulkijamekanismin heikkous Sidekudosten heikkous: ikääntyminen, raskaudet tai hormonaaliset syyt
Elintavat: lihavuus, tupakointi Lantionpohjan lihasten hermotushäiriö tai vamma: synnynnäinen tai ikääntymisen, synnytyksen, leikkauksen tai tapaturman aiheuttama
Pakkovirtsankarkailu eli virtsan karkaaminen äkillisen virtsaamispakon yhteydessä samanaikaisesti virtsaamispakko-oireen kanssa tai heti sen jälkeen Rakkolihaksen supistelu:
  • neurogeeninen
Keskushermoston sairaus tai vamma, neuropatia, diabetes, psykosomaattiset tekijät
  • ei-neurogeeninen
Infektio (akuutti virtsatieinfektio tai toistuvat virtsatieinfektiot), kasvain, rakon seinämän sairaus, rakkokivi, atrofia, rakon nopea täyttyminen, elintavat
  • idiopaattinen
Sekatyyppinen virtsankarkailu eli yhtäaikainen ponnistus- ja pakkovirtsankarkailu Ponnistus- ja pakkoinkontinenssin mekanismit yhdessä Mainittujen aiheuttajien yhdistelmät
Ylivuotovirtsankarkailu eli virtsan karkaaminen, johon liittyy virtsarakon akuutti tai krooninen tyhjenemishäiriö eli virtsaretentio Heikentynyt virtsaamisheijaste Hermoston sairaus tai vamma, leikkauksen jälkitila, lääkehoito
Mekaaninen este Kasvain, laskeuma, leikkauskomplikaatio (esim. tiukka nauhaleikkaus)
Fistelit ja anomaliat Synnynnäinen, toimenpiteestä johtuva tai anoksinen vaurio Leikkaus, sädehoito tai synnytykseen liittyvä vamma

Esiintyvyys ja riskitekijät

Taulukko 2. Virtsankarkailun taustatekijöiden riskisuhteita 1, 2)
Tekijä Riskisuhde (95 %:n luottamusväli) Kirjallisuusviite
Ikä 1,14 (1,08–1,21) jokaista kymmentä ikävuotta kohti, ikävuosien 30–90 välillä «Melville JL, Katon W, Delaney K ym. Urinary incontinence in US women: a population-based study. Arch Intern Med 2005;165:537-42 »41, «Zhu L, Lang J, Liu C ym. The epidemiological study of women with urinary incontinence and risk factors for stress urinary incontinence in China. Menopause 2009;16:831-6 »42
Lihavuus, verrattuna normaalipainoisiin
– BMI 30–34 kg/m2 3,1 (2,6–3,7) «Hannestad YS, Rortveit G, Daltveit AK ym. Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT Study. BJOG 2003;110:247-54 »20
– BMI vähintään 40 kg/m2 5,0 (3,4–7,3) «Hannestad YS, Rortveit G, Daltveit AK ym. Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT Study. BJOG 2003;110:247-54 »20
Raskaus ja synnyttäneisyys «Rortveit G, Hannestad YS, Daltveit AK ym. Age- and type-dependent effects of parity on urinary incontinence: the Norwegian EPINCONT study. Obstet Gynecol 2001;98:1004-10 »16, «Wesnes SL, Rortveit G, Bø K ym. Urinary incontinence during pregnancy. Obstet Gynecol 2007;109:922-8 »22, «Tähtinen RM, Cartwright R, Tsui JF ym. Long-term Impact of Mode of Delivery on Stress Urinary Incontinence and Urgency Urinary Incontinence: A Systematic Review and Meta-analysis. Eur Urol 2016;70:148»25
– alatiesynnytys verrattuna synnyttämättömiin 2,3 (2,0–2,6) «Rortveit G, Daltveit AK, Hannestad YS ym. Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med 2003;348:900-7 »43
– keisarileikkaus verrattuna synnyttämättömiin 1,5 (1,2–1,9) «Rortveit G, Daltveit AK, Hannestad YS ym. Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med 2003;348:900-7 »43
– alatiesynnytys verrattuna keisarileikkaukseen 1,85 (1,56–2,19) «Tähtinen RM, Cartwright R, Tsui JF ym. Long-term Impact of Mode of Delivery on Stress Urinary Incontinence and Urgency Urinary Incontinence: A Systematic Review and Meta-analysis. Eur Urol 2016;70:148»25
– 3.–4. asteen repeämä 4,0 (2,3–6,9) «Hatem M, Pasquier JC, Fraser W ym. Factors associated with postpartum urinary/anal incontinence in primiparous women in Quebec. J Obstet Gynaecol Can 2007;29:232-9 »44
Kohdunpoisto «Brown JS, Sawaya G, Thom DH ym. Hysterectomy and urinary incontinence: a systematic review. Lancet 2000;356:535-9 »45
– ikävakioimaton 1,4 (1,2–1,7)
– riski joutua karkailun vuoksi leikkaushoitoon 2,4 (2,3–2,5) «Altman D, Granath F, Cnattingius S ym. Hysterectomy and risk of stress-urinary-incontinence surgery: nationwide cohort study. Lancet 2007;370:1494-9 »46
Perussairaudet, vähintään kaksi 4,4 (2,5–7,7) «Holroyd-Leduc JM, Straus SE. Management of urinary incontinence in women: scientific review. JAMA 2004;291:986-95 »47
Tyypin 2 diabetes
– virtsankarkailu
1,28 (1,18–1,39) «Lifford KL, Curhan GC, Hu FB ym. Type 2 diabetes mellitus and risk of developing urinary incontinence. J Am Geriatr Soc 2005;53:1851-7 »48
– pakkovirtsankarkailu 1,5 (1,0–2,2), 1,4 (1,0–1,9) «Ebbesen MH, Hannestad YS, Midthjell K ym. Diabetes and urinary incontinence - prevalence data from Norway. Acta Obstet Gynecol Scand 2007;86:1256-62 »34, «Danforth KN, Townsend MK, Curhan GC ym. Type 2 diabetes mellitus and risk of stress, urge and mixed urinary incontinence. J Urol 2009;181:193-7 »35
– ponnistusvirtsankarkailu
– sekamuotoinen virtsankarkailu
1,1 (0,9–1,4)
1,3 (1,1–1,7), 0,9 (0,7–1,3)
«Ebbesen MH, Hannestad YS, Midthjell K ym. Diabetes and urinary incontinence - prevalence data from Norway. Acta Obstet Gynecol Scand 2007;86:1256-62 »34, «Danforth KN, Townsend MK, Curhan GC ym. Type 2 diabetes mellitus and risk of stress, urge and mixed urinary incontinence. J Urol 2009;181:193-7 »35
– vaikea-asteinen virtsankarkailu 1,5 (1,2–2,0) «Ebbesen MH, Hannestad YS, Midthjell K ym. Diabetes and urinary incontinence - prevalence data from Norway. Acta Obstet Gynecol Scand 2007;86:1256-62 »34
Perintötekijät ponnistusvirtsankarkailu 1,5 (1,3–1,8) «Hannestad YS, Lie RT, Rortveit G ym. Familial risk of urinary incontinence in women: population based cross sectional study. BMJ 2004;329:889-91 »49
sekamuotoinen virtsankarkailu 1,6 (1,2–2,0)
pakkovirtsankarkailu 1,8 (0,8–3,9)
Lantionpohjan lihasten heikkous 3,4 (0,51–23) «Samuelsson E, Victor A, Svärdsudd K. Determinants of urinary incontinence in a population of young and middle-aged women. Acta Obstet Gynecol Scand 2000;79:208-15 »50, «Burti JS, Hacad CR, Zambon JP ym. Is there any difference in pelvic floor muscles performance between continent and incontinent women? Neurourol Urodyn 2015;34:544-8 »51
Toistuvat virtsatietulehdukset (pakkovirtsankarkailu) 2,0 (1,1–3,6) «Brown JS, Grady D, Ouslander JG ym. Prevalence of urinary incontinence and associated risk factors in postmenopausal women. Heart & Estrogen/Progestin Replacement Study (HERS) Research Group. Obstet G»52
Suolen toiminnan häiriöt
– ummetus tai ripuli 2,0 (1,3–3,0) «van Beurden M, van Der Vange N, ten Kate FJ ym. Restricted surgical management of vulvar intraepithelial neoplasia 3: Focus on exclusion of invasion and on relief of symptoms. Int J Gynecol Cancer 199»53
– ulosteen karkailu 5,8 (1,8–18,2) «Slieker-ten Hove MC, Pool-Goudzwaard AL, Eijkemans MJ ym. Prevalence of double incontinence, risks and influence on quality of life in a general female population. Neurourol Urodyn 2010;29:545-50 »54
– ponnistusvirtsankarkailu 1,3 (1,1–1,5) «Hannestad YS, Rortveit G, Daltveit AK ym. Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT Study. BJOG 2003;110:247-54 »20
– sekamuotoinen virtsankarkailu 1,5 (1,3–1,8)
Tupakointi yli 20 savuketta päivässä 1,3 (1,1–1,6) «Hannestad YS, Rortveit G, Daltveit AK ym. Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT Study. BJOG 2003;110:247-54 »20
Heikentynyt toimintakyky
– päivittäistoiminnot (ADL) 2,3 (1,2–4,3) «Maggi S, Minicuci N, Langlois J ym. Prevalence rate of urinary incontinence in community-dwelling elderly individuals: the Veneto study. J Gerontol A Biol Sci Med Sci 2001;56:M14-8 »18
– pakko- tai sekamuotoinen virtsankarkailu 3,6 (1,7–7,3) «Nuotio M, Jylhä M, Luukkaala T ym. Urinary incontinence in a Finnish population aged 70 and over. Prevalence of types, associated factors and self-reported treatments. Scand J Prim Health Care 2003;21»55
– ponnistusvirtsankarkailu 0,8 (0,3–2,0)
Heikentynyt liikuntakyky
– poikkileikkausaineisto 2,1 (1,2–3,9) «Maggi S, Minicuci N, Langlois J ym. Prevalence rate of urinary incontinence in community-dwelling elderly individuals: the Veneto study. J Gerontol A Biol Sci Med Sci 2001;56:M14-8 »18
– pitkittäisaineisto; lievä virtsankarkailu 1,6 (1,1–2,2) «Jenkins KR, Fultz NH. Functional impairment as a risk factor for urinary incontinence among older Americans. Neurourol Urodyn 2005;24:51-5 »56
– pitkittäisaineisto; vaikea virtsankarkailu 2,0 (1,1–3,5)
Selkäkipu 18–23-vuotiailla 1,3 (1,2–1,4)
45–50-vuotiailla 1,7 (1,4–2,2)
70–75-vuotiailla 2,4 (1,6–3,7)
«Selkäkivun ja virtsankarkailun yhteys toisiinsa»5
«Smith MD, Russell A, Hodges PW. The relationship between incontinence, breathing disorders, gastrointestinal symptoms, and back pain in women: a longitudinal cohort study. Clin J Pain 2014;30:162-7 »57
1) Suurin osa riski- ja taustatekijöitä koskevista tiedoista on saatu poikkileikkaustutkimuksista. Toistaiseksi on tehty hyvin vähän kontrolloituja tutkimuksia, jotka osoittaisivat, että riskitekijään kohdistuva interventio vähentäisi virtsankarkailun ilmaantuvuutta tai vaikeutta.
2) Virtsankarkailun vaikeusaste vaihtelee tutkimuksittain.
Taulukko 3. Virtsankarkailua mahdollisesti aiheuttavia tai pahentavia lääkeaineita, jotka on syytä huomioida erityisesti iäkkäillä. Lääkeaineryhmät luetellaan aakkosjärjestyksessä.
Lääkeaine Vaikutustapa
ACE:n estäjät Yskä, ponnistusvirtsankarkailu
Alfa-adrenergiset antagonistit (esim. pratsosiini) Vähentävät sileän lihaksen tonusta virtsaputkessa, ponnistusvirtsankarkailu
Antihistamiinit Sekavuus
Antikolinergit Tyhjenemisvaikeudet, virtsaumpi, ummetus, ylivuotovirtsankarkailu
Kognitiiviset häiriöt, WC:ssä käyntitaitojen heikentyminen
Asetyylikolinesteraasin estäjät (Alzheimerin taudissa käytettävät) Virtsarakon supistumisherkkyyden lisääntyminen, pakkovirtsankarkailu
Bentsodiatsepiinit Sekavuus, liikuntakyvyn heikentyminen
Diureetit Virtsanerityksen ja virtsamäärien lisääntyminen, pakkovirtsankarkailu
Gabapentiini Turvotukset, yöllinen polyuria
Sekavuus
Kalsiuminestäjät Tyhjenemisvaikeudet, virtsaumpi, ummetus
Litium Polyuria
Opiaatit Tyhjenemisvaikeudet, virtsaumpi, ummetus, sekavuus, liikuntakyvyn heikentyminen
Psykoosilääkkeet Antikolinergivaikutukset
SSRI-lääkkeet Kolinerginen, rakkosupistuksia lisäävä vaikutus
Tulehduskipulääkkeet Turvotukset, yöllinen polyuria

Esiintyvyys neurologisten sairauksien yhteydessä

Taulukko 4. Virtsankarkailun esiintyvyys eräiden neurologisten sairauksien yhteydessä
Neurologinen sairaus Esiintyvyys (molemmat sukupuolet yhteensä)
Akuutti tulehduksellinen demyelinoiva polyneuropatia (AIDP), Guillain–Barrén oireyhtymä (akuutti vaihe) «Sakakibara R, Hattori T, Kuwabara S ym. Micturitional disturbance in patients with Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry 1997;63:649-53 »67, «Zochodne DW. Autonomic involvement in Guillain-Barré syndrome: a review. Muscle Nerve 1994;17:1145-55 »68 Harvoin
Aivohalvaus «Ruffion A, Castro-Diaz D, Patel H ym. Systematic review of the epidemiology of urinary incontinence and detrusor overactivity among patients with neurogenic overactive bladder. Neuroepidemiology 2013;»61, «Williams MP, Srikanth V, Bird M ym. Urinary symptoms and natural history of urinary continence after first-ever stroke--a longitudinal population-based study. Age Ageing 2012;41:371-6 »69
– elämänaikainen 24 %
– akuutti vaihe 44 %
– 12 kk sairastumisesta 38 %
Dementia «Ouslander JG, Zarit SH, Orr NK ym. Incontinence among elderly community-dwelling dementia patients. Characteristics, management, and impact on caregivers. J Am Geriatr Soc 1990;38:440-5 »59, «Hägglund D. A systematic literature review of incontinence care for persons with dementia: the research evidence. J Clin Nurs 2010;19:303-12 »60
– kotona asuvat Miehet 35 % Naiset 37 %
– pitkäaikaishoidossa olevat 78 %
Lannerangan välilevytyrä «Fraser S, Roberts L, Murphy E. Cauda equina syndrome: a literature review of its definition and clinical presentation. Arch Phys Med Rehabil 2009;90:1964-8 »66 Harvoin
Multippeliskleroosi «Ruffion A, Castro-Diaz D, Patel H ym. Systematic review of the epidemiology of urinary incontinence and detrusor overactivity among patients with neurogenic overactive bladder. Neuroepidemiology 2013;»61 51 %
Parkinsonin tauti «Ruffion A, Castro-Diaz D, Patel H ym. Systematic review of the epidemiology of urinary incontinence and detrusor overactivity among patients with neurogenic overactive bladder. Neuroepidemiology 2013;»61 33 %

Diagnostiikka

Kyselylomakkeet

Anamneesi

Kliininen tutkimus

Gynekologinen tutkimus

Erityispiirteet haurailla (gerasteenisilla) tai monisairailla

Laboratoriotutkimukset

Täydentävät tutkimukset

  • Täydentäviä tutkimuksia ovat kystoskopia, urodynaamiset mittaukset ja kuvantamistutkimukset, joita tarvitaan (ks. Hoitokaavio «»1), kun
    • esiintyy epätyypillisiä oireita (esim. virtsarakon tyhjenemisvaikeuksia, ylivuotovirtsankarkailua, rakon ärsytysoireita) tai oireet ovat alkaneet äkillisesti
    • virtsankarkailun tyypin määrittäminen on kliinisesti hankalaa
    • vaste hoitoon on huono (lääkehoidon tehottomuus, leikkaushoidon jälkeen uusiutunut virtsankarkailu)
    • epäillään neurologista sairautta
    • epäillään virtsarakon sairautta (esim. rakon kipuoireyhtymä, rakkokivi tai -syöpä), alavatsan kasvainta (esim. munasarjakasvain, kookas myooma) tai fisteliä
    • virtsankarkailu on uusiutunut leikkauksen jälkeen.

Kystoskopia

Urodynaamiset mittaukset

  • Urodynaamisia mittauksia käytetään, kun halutaan määrittää tarkemmin virtsankarkailun tyyppi ja sen vaikeusaste tai suunnitellaan uusiutuneen virtsankarkailun leikkaushoitoa «Urodynaamiset mittaukset naisen virtsainkontinenssin diagnostiikassa»14.
  • Tutkimus koostuu neljästä osasta:
    • virtsasuihkun virtausmittauksesta (flowmetria)
    • siihen liitetystä jäännösvirtsan mittauksesta
    • rakon painemittauksesta (kystometria)
    • virtsaputken painemittauksesta.
  • Tutkimusmenetelmät eivät ole standardoituja, ja ne vaihtelevat sairaaloittain, tutkijoittain ja laitteistoittain.

Kuvantamistutkimukset

Ehkäisy

Hoito

  • Ks. myös kaavio virtsankarkailun diagnostiikasta ja hoidosta avoterveydenhuollossa «»1.

Elintapamuutokset

Lantionpohjan lihasharjoittelu ja fysioterapia

Kirurginen hoito ponnistusvirtsankarkailussa

Nauhaleikkaukset

Nauhaleikkauksen yhdistäminen laskeumaleikkauksiin

Mininauhat

Muut leikkaukset

Virtsaputken ympärille ruiskutettava injektiohoito

Muut kajoavat hoidot

Uusiutuneen ponnistusvirtsankarkailun leikkaushoito

Lääkehoito ponnistusvirtsankarkailussa

Lääkehoito pakkovirtsankarkailussa

  • Pakkovirtsankarkailun lääkehoidosta esitetään kooste taulukossa «Pakkovirtsankarkailun lääkehoito»5.
  • Myös sekatyyppisen virtsankarkailun hoidossa voidaan lääkehoitoa käyttää, jos pakkokarkailu on vallitseva oire.
Taulukko 5. Pakkovirtsankarkailun lääkehoito
Valmistemuoto Annostus Kommentteja
Estrogeenipaikallishoitovalmisteet Paikallinen ärsytys, kutina ja kirvely lähinnä hoidon aloitusvaiheessa; ei systeemisiä haittavaikutuksia «Emättimeen annosteltava paikallinen estrogeenihoito lievittää pakkovirtsankarkailun oireita vaihdevuosi-iän ylittäneillä naisilla.»B
Estradioli Emätintabletti 10 µg kahdesti viikossa Tarvittaessa voidaan annostella tiheämmin
3 kk:n välein vaihdettava rengas 7,5 µg/vrk
Estrioli Emätinvoide 0,1 mg/g (100 g) ja 1 mg/g (15 g) asetin, emätinpuikko 0,5 mg Kahtena iltana viikossa Tarvittaessa voidaan annostella tiheämmin
Antikolinergiset lääkkeet (aakkosjärjestyksessä) NNT1) antikolinergeille (95 % CI) «Shamliyan T, Wyman JF, Ramakrishnan R ym. Benefits and harms of pharmacologic treatment for urinary incontinence in women: a systematic review. Ann Intern Med 2012;156:861-74, W301-10 »147
Darifenasiini Tabletti Aloitusannos 7,5 mg x 1, suurennetaan tarvittaessa määrään 15 mg x 1 9 (6–18) 2)
Fesoterodiini Tabletti Aloitusannos 4 mg x 1; suurennetaan tarvittaessa määrään 8 mg x 1 8 (5–17)
Oksibutyniini Lyhytvaikutteinen tabletti 3 mg x 2–3 5 mg x 2–3 9 (6–16) kaikki annosmuodot
Pitkävaikutteinen tabletti (tyhjään mahaan) 10 mg x 1
Laastari, vaihto kahdesti viikossa 3,9 mg/vrk
Solifenasiini Tabletti Aloitusannos 5 mg x 1; suurennetaan tarvittaessa määrään 10 mg x 1 9 (6–17)
Tolterodiini Lyhytvaikutteinen tabletti Pitkävaikutteinen tabletti 2 mg x 2 4 mg x 1 12 (8–25) molemmat annosmuodot
Trospiumkloridi Lyhytvaikutteinen tabletti 20 mg x 2 9 (7–12) molemmat annosmuodot
Pitkävaikutteinen tabletti 60 mg x 1
Beeta3-adrenergisen reseptorin agonisti
Mirabegroni Pitkävaikutteinen tabletti 50 mg x 1;
25 mg x 1 mikäli merkittävä munuaisten tai maksan vajaatoiminta
Erilainen haittavaikutusprofiili kuin antikolinergeilla, ei suun kuivumista tai ummetusta
Saattaa hieman nostaa verenpainetta ja altistaa rytmihäiriöille, erityisesti palpitaatiolle «Duckett J, Balachandran A. Tolerability and persistence in a large, prospective case series of women prescribed mirabegron. Int Urogynecol J 2016;27:1163-7 »148
1) NNT (number needed to treat): se määrä potilaita, joka tulee hoitaa, jotta yksi paranisi
2) Darifenasiinin tapauksesta NNT-luku on annettu siitä määrästä potilaita, joilla oire lievittyi.

Estrogeeni

Antikolinergiset eli antimuskariinilääkkeet ja beeta3-agonisti (mirabegroni)

Iäkkäiden, hauraiden (gerasteenisten), monisairaiden ja muistihäiriöisten lääkehoito

Uusiutuneen pakkovirtsankarkailun hoito

Muut hoidot pakkovirtsankarkailussa

Kirurginen hoito pakkovirtsankarkailussa

Apuvälineet ja hoitotarvikkeet

Iäkkäiden hoidon erityispiirteet

Virtsankarkailun hoitojen taloudellinen arviointi

Hoidon porrastus ja seuranta

Suomalaisen Lääkäriseuran Duodecimin ja Suomen Gynekologiyhdistyksen asettama työryhmä

Virtsankarkailu (naiset) -suosituksen historiatiedot «Virtsankarkailu (naiset), Käypä hoito -suosituksen historiatiedot»24

Puheenjohtaja:

Tomi Mikkola, LT, dosentti, osastonylilääkäri, synnytysten ja naistentautien erikoislääkäri; HYKS Naistenklinikka

Kokoava kirjoittaja:

Seija Ala-Nissilä, LT, naistentautien ja synnytysten sekä gynekologisen endoskopian erikoislääkäri; Tyksin Naistenklinikka

Jäsenet:

Olavi Airaksinen, fysiatrian dosentti, ylilääkäri, fysiatrian erikoislääkäri, kivunhoidon ja kuntoutuksen erityispätevyys; KYS:n fysiatrian klinikka

Pauliina Aukee, LT, osastonylilääkäri, synnytysten ja naistentautien erikoislääkäri, urogynekologian ja lääkärikouluttajan erityispätevyys; Keski-Suomen keskussairaalan synnytys- ja naistentautien sekä Lantionpohjan tutkimus- ja hoitoyksikkö

Maria Nuotio, LT, ylilääkäri, geriatrian ja yleislääketieteen erikoislääkäri; Seinäjoen keskussairaala, geriatrian toimintayksikkö

Ilkka Perttilä, LL, urologi, osastonlääkäri; HUS, vatsakeskus, urologian linja

Kaisa Raatikainen, LT, dosentti, naistentautien ja synnytysten erikoislääkäri, urogynekologian lisäkoulutus, kliininen opettaja; Itä-Suomen yliopisto ja KYS

Juhani Ruutiainen, neurologian dosentti, vastaava ylilääkäri, kuntoutuksen erityispätevyys; Neuroliitto ry

Eeva Sundström, LL, yleislääketieteen erikoislääkäri, lääkärikouluttajan erityispätevyys; Vantaan kaupunki, Tikkurilan terveysasema ja Helsingin yliopisto

Minna Törnävä, TtM, fysioterapeutti, seksuaaliterapeutti (NACS); PSHP, TAYS, TA3, Fysiatrian yksikkö

Piia Vuorela, LT, KTK, dosentti, synnytys- ja naistentautiopin erikoislääkäri Käypä hoito -toimittaja

Asiantuntijat:

Heidi Alenius, LL, yleislääketieteen erikoislääkäri, lääkäri-toimittaja; Lempäälän terveyskeskus ja Kustannus Oy Duodecimin Lääkärin tietokannat

Pirjo Räsänen, dosentti, FT, erikoissairaanhoitaja, uroterapeutti, arviointijohtaja; Helsingin ja Uudenmaan sairaanhoitopiiri

Sidonnaisuudet

Olavi Airaksinen: Luentopalkkio (GSK 2015, MSD 2014-2016, Orion 2014-2016, Pfizer 2014-2016, Sanofi 2014-2016), Muu palkkio (Sanchio Pharma, Pfixzer)

Seija Ala-Nissilä: Asiantuntijapalkkio (Astellas Pharma, Fimea), Luentopalkkio (Astellas Pharma), Korvaukset koulutus – ja kongressikuluista (Astellas Pharma)

Pauliina Aukee: Luentopalkkio (Allergan Norden AB, Ti-Me Ajaton terveys Oy), Korvaukset koulutus – ja kongressikuluista (Astellas Oy, UpViser Oy)

Tomi Mikkola: Apuraha (Contura), Luentopalkkio (Astellas Pharma, Mylan, Novo Nordisk)

Maria Nuotio: Ei sidonnaisuuksia

Ilkka Perttilä: Luentopalkkio (Astellas Pharma, Coloplast, Omnia), Korvaukset koulutus – ja kongressikuluista (Astellas Pharma)

Kaisa Raatikainen: Luentopalkkio (Astellas pharma), Korvaukset koulutus – ja kongressikuluista (Astellas, Olympus, Endomed, EU Horizon 2020)

Juhani Ruutiainen: Ei sidonnaisuuksia

Eeva Sundström: Ei sidonnaisuuksia.

Minna Törnävä: Asiantuntijapalkkio (eri maksajia), Luentopalkkio (eri maksajia)

Piia Vuorela: Ei sidonnaisuuksia.

Kirjallisuusviite

Virtsankarkailu (naiset) (online). Suomalaisen Lääkäriseuran Duodecimin ja Suomen Gynekologiyhdistyksen asettama työryhmä. Helsinki: Suomalainen Lääkäriseura Duodecim, 2017 (viitattu pp.kk.vvvv). Saatavilla internetissä: www.kaypahoito.fi

Tarkemmat viittausohjeet: «http://www.kaypahoito.fi/web/kh/viittaaminen»18

Vastuun rajaus

Käypä hoito -suositukset ovat parhaiden asiantuntijoiden laatimia yhteenvetoja yksittäisten sairauksien diagnostiikan ja hoidon vaikuttavuudesta. Ne eivät korvaa lääkärin tai muun terveydenhuollon ammattilaisen omaa arviota yksittäisen potilaan parhaasta mahdollisesta diagnostiikasta ja hoidosta hoitopäätöksiä tehtäessä.

Tiedonhakukäytäntö

Systemaattinen kirjallisuushaku on hoitosuosituksen perusta. Lue lisää artikkelista khk00007

Kirjallisuutta

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