Urinary Incontinence - Renal - Medbullets Step 1

Snapshot
- A 42-year-old woman presents to her primary care physician due to involuntary passage of urine. She reports to voiding small amounts of urine throughout the day and night. She says that this occurs without warning. Medical history is significant for multiple sclerosis treated with ocrelizumab. Physical examination is notable for a distended bladder. (Overflow incontinence secondary to multiple sclerosis)

                        Introduction
                    
                        Clinical definition
                    
                        involuntary urinary leakage
                    
                        Diagnostic studies
                    
                        all patients with urinary incontinence should have a urinalysis
                    
                        if symptoms are concerning for a urinary tract infection obtain a urine culture
                    
                        Urinary Incontinence
Type
PathogenesisPresentation
DiagnosisTreatment
Stress incontinenceMay be secondary to a number of factors such asweakened pelvic floor musclese.g., vaginal deliveries
poor intrinsic sphincter function
increased urethral mobility
Urinary incontinence with↑ intra-abdominal pressuree.g., coughing, sneezing, laughing, and physical exertion
No urine loss at night
Physical exama cystocelemay be present
Q-tip test
Strengthening the pelvic floor muscles viaKegel exercisesfirst-line
Topical estrogen for post-menopausal women
Pessary
Midurethral sling in patients unresponsive to initial therapy and pessary
Urge incontinence
Detrusor muscle overstimulation
Frequent urinary leakage that also occurs at nightdisrupts sleep
Urge to urinate and may be unable to reach the bathroom in time
Urodynamic testing
Antimuscarinicse.g.,oxybutynin
Mirabegron
Overflow incontinenceIncomplete bladder emptying results in urinary leakage secondary to
detrusor muscle underactivitye.g., age, diabetes mellitus, and multiple sclerosis
bladder outlet obstructione.g., fibroids and benign prostatic hyperplasia
Urine loss without warning or triggers
Post-void residual volume measurements
Urodynamic testing
Clean intermittent catheterization
Mixed Incontinence-Symptoms of both stress and urge incontinence
-Lifestyle modifications and pelvic floor exercises are first-line
If unresponsive to first-line treatments then therapy is based on the predominant symptoms

Action	Numeric Key	Letter Key	Function Key
Show Bullets		S	Enter (frontside only)
20%	1	N
40%	2	H
60%	3	F	Enter (backside only)
80%	4	E
100%	5	M
Toss	0	T

Urinary Incontinence
Type	Pathogenesis	Presentation	Diagnosis	Treatment
Stress incontinence	May be secondary to a number of factors such as weakened pelvic floor muscles e.g., vaginal deliveries poor intrinsic sphincter function increased urethral mobility	Urinary incontinence with↑ intra-abdominal pressure e.g., coughing, sneezing, laughing, and physical exertion No urine loss at night Physical exam a cystocelemay be present	Q-tip test	Strengthening the pelvic floor muscles via Kegel exercises first-line Topical estrogen for post-menopausal women Pessary Midurethral sling in patients unresponsive to initial therapy and pessary
Urge incontinence	Detrusor muscle overstimulation	Frequent urinary leakage that also occurs at night disrupts sleep Urge to urinate and may be unable to reach the bathroom in time	Urodynamic testing	Antimuscarinics e.g.,oxybutynin Mirabegron
Overflow incontinence	Incomplete bladder emptying results in urinary leakage secondary to detrusor muscle underactivity e.g., age, diabetes mellitus, and multiple sclerosis bladder outlet obstruction e.g., fibroids and benign prostatic hyperplasia	Urine loss without warning or triggers	Post-void residual volume measurements Urodynamic testing	Clean intermittent catheterization
Mixed Incontinence	-	Symptoms of both stress and urge incontinence	-	Lifestyle modifications and pelvic floor exercises are first-line If unresponsive to first-line treatments then therapy is based on the predominant symptoms