Urinary and reproductive systems
AMA5 Chapter 7 (p 143) applies to the assessment of permanent impairment of the urinary and reproductive systems, subject to the modifications set out below. Before undertaking an impairment assessment, users of the Guidelines must be familiar with:
- the Introduction in the Guidelines
- chapters 1 and 2 of AMA5
- the appropriate chapter(s) of the Guidelines for the body system they are assessing
- the appropriate chapter(s) of AMA5 for the body system they are assessing.
The Guidelines take precedence over AMA5.
Introduction
7.1 AMA5 Chapter 7 (pp 143–71) provides clear details for assessment of the urinary and reproductive systems. Overall, the chapter should be followed in assessing permanent impairment, with the variations included below.
7.2 For both male and female sexual dysfunction, identifiable pathology should be present for an impairment percentage to be given.
Urinary diversion
7.3 AMA5 Table 7-2 (p 150) should be replaced with Table 7.1, below, when assessing permanent impairment due to urinary diversion disorders. This table includes ratings for neobladder and continent urinary diversion.
7.4 Continent urinary diversion is defined as a continent urinary reservoir constructed of small or large bowel with a narrow catheterisable cutaneous stoma through which it must be emptied several times a day.
Table 7.1: Criteria for rating permanent impairment due to urinary diversion disorders
| Diversion type | % Impairment of the whole person |
|---|---|
| Ureterointestinal | 10 |
| Cutaneous ureterostomy | 10 |
| Nephrostomy | 15 |
| Neobladder/replacement cystoplasty | 15 |
| Continent urinary diversion | 20 |
Bladder
7.5 AMA5 Table 7-3 (p 151) should be replaced with Table 7.2, below, when assessing permanent impairment due to bladder disease. This table includes ratings involving urge and total incontinence (defined in 7.8 of the Guidelines).
Table 7.2: Criteria for rating permanent impairment due to bladder disease
| Class 1 0-15% impairment of the whole person | Class 2 16-40% impairment of the whole person | Class 3 41-70% impairment of the whole person |
|---|---|---|
Symptoms and signs of bladder disorder and requires intermittent treatment and normal functioning between malfunctioning episodes | Symptoms and signs of bladder disorder eg urinary frequency (urinating more than every two hours), severe nocturia (urinating more than three times a night), urge incontinence more than once a week and requires continuous treatment | Abnormal (ie under or over) reflex activity (eg intermittent urine dribbling, loss of control, urinary urgency and urge incontinence once or more each day) and/or no voluntary control of micturition, reflex or areflexic bladder on urodynamics and/or total incontinence eg fistula. |
7.6 AMA5 example 7-16 (p 151) should be reclassified as an example of class 2, as the urinary frequency is more than every two hours and continuous treatment would be expected.
Urethra
7.7 AMA5 Table 7-4 (p 153) should be replaced with Table 7.3 below when assessing permanent impairment due to urethral disease. This table includes ratings involving stress incontinence.
Urinary incontinence
7.8 Urge urinary incontinence is the involuntary loss of urine associated with a strong desire to void. Stress urinary incontinence is the involuntary loss of urine occurring with clinically demonstrable raised intra-abdominal pressure. It is expected that urinary incontinence of a regular or severe nature (necessitating the use of protective pads or appliances) will be assessed as follows:
| Stress urinary incontinence (demonstrable clinically) | 11-25%, according to severity |
| Urge urinary incontinence | 16-40%, according to severity |
| Mixed (urge and stress) incontinence | 16-40%, according to severity |
| Nocturnal enuresis or wet in bed | 16-40%, according to severity |
| Total incontinence (continuously wet - eg from fistula) | 50-70% |
The highest scoring condition is to be used to assess impairment - combinations are not allowed.
Male reproductive organs
7.9 Penis
7.9 On page 157 of AMA5, the box labelled ‘class 3, 21–35% impairment of the whole person’ should read ‘class 3, 20% impairment of the whole person’, as the descriptor ‘no sexual function possible’ does not allow a range. (The correct value is shown in AMA5 Table 7-5, p 156). Note, however, that there is a loading for age, so a rate higher than 20% is possible.
7.10 - 7.12 Testicles, epididymides and spermatic cords
7.10 AMA5 Table 7-7 (p 159) should be replaced with Table 7.4, below, when assessing permanent impairment due to testicular, epididymal and spermatic cord disease. This table includes rating for infertility and equates impairment with female infertility (see Table 7.5 in the Guidelines). Infertility in either sex must be considered to be of equal impact, age for age.
7.11 Male infertility is defined as azoospermia or other cause of inability to cause impregnation, even with assisted contraception techniques.
7.12 Loss of sexual function related to spinal injury should only be assessed as an impairment where there is other objective evidence of spinal cord, cauda equina or bilateral nerve root dysfunction. The ratings described in AMA5 Table 13-21 (p 342) are used in this instance. There is no additional impairment rating system for loss of sexual function in the absence of objective clinical findings.
Table 7.4: Criteria for rating permanent impairment due to testicular, epididymal and spermatic cord disease
| Class 1 0-10% impairment of the whole person | Class 2 11-15% impairment of the whole person | Class 3 16-35% impairment of the whole person |
|---|---|---|
Testicular, epididymal or spermatic cord disease symptoms and signs and anatomic alteration and no continuous treatment required and no seminal or hormonal function or abnormalities or solitary testicle | Testicular, epididymal or spermatic cord disease symptoms and signs and anatomic alteration and cannot effectively be controlled by treatment and detectable seminal or hormonal abnormalities | Trauma or disease produces bilateral anatomic loss of the primary sex organs or no detectable seminal or hormonal function or infertility |
Female reproductive organs
7.13 - 7.14 Fallopian tubes and ovaries
7.13 AMA5 Table 7-11 (p 167) should be replaced with Table 7.5, below, when assessing permanent impairment due to fallopian tube and ovarian disease. This table includes rating for infertility and equates impairment with male infertility (see Table 7.4, above). Infertility in either sex must be considered to be of equal impact, age for age.
7.14 Female infertility: A woman in the childbearing age is infertile when she is unable to conceive naturally. This may be due to anovulation, tubal blockage, cervical or vaginal blocking or an impairment of the uterus.
Table 7.5: Criteria for rating permanent impairment due to fallopian tube and ovarian disease
| Class 1 0-15% impairment of the whole person | Class 2 16-25% impairment of the whole person | Class 3 26-35% impairment of the whole person |
|---|---|---|
Fallopian tube or ovarian disease or deformity symptoms and signs do not require continuous treatment or only one functioning fallopian tube or ovary in the premenopausal period or bilateral fallopian tube or ovarian functional loss in the postmenopausal period | Fallopian tube or ovarian disease or deformity symptoms and signs require continuous treatment, but tubal patency persists and ovulation is possible | Fallopian tube or ovarian disease deformity symptoms and signs and total tubal patency loss or failure to produce ova in the premenopausal period or bilateral fallopian tube or bilateral ovarian loss in the premenopausal period; infertility |