BackTable / Urology / Topic / Condition
Urinary incontinence involves the involuntary leakage of urine. The types of urinary incontinence can be categorized into stress, urge, functional, mixed, and overflow incontinence. While younger adults can be affected by this condition, it is more prevalent in elderly adults. Patients with mixed urinary incontinence present with a combination of stress and urge urinary incontinence symptoms. This can occur from urethral sphincter and pelvic floor weakness or detrusor overactivity. Bladder irritation and loss of neurologic control are associated with urge urinary incontinence. Overflow urinary incontinence occurs due to an overdistended bladder and is common in men with benign prostatic hyperplasia. Functional urinary incontinence may result from physical barriers to toileting. Patients that are pregnant or have given birth, have diabetes, or have a high body mass index are at an increased risk of incontinence.
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Urinary Incontinence Diagnosis
Voiding diaries are useful in the diagnosis of incontinence, and a patient’s history will help specify the type of urinary incontinence. A brief questionnaire of the 3 Incontinence Questions (3IQ) is helpful in distinguishing between incontinence and other causes of urine leakage. A physical exam should be performed, and in some cases, a cough stress test and cotton swab test are useful. Additionally, in women, a gynecologic history should be taken and estrogen status should be determined. During perimenopause, atrophic vaginitis and urethritis can contribute to reversible urinary incontinence. Laboratory tests are not always necessary, but they are beneficial for ruling out other conditions.
Urinary Incontinence Podcasts
Listen to leading physicians discuss urinary incontinence on the BackTable Urology Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.
Dr. Daniel Hoffman, a urogynecologist specializing in voiding dysfunction, discuss the use of Botox, sacral neuromodulation, and bulking agents in treating overactive bladders. Listen to hear more about patient selection criteria for each treatment, botox and neuromodulation procedure techniques, and treatment side effects and complications.
Urologist Dr. Francisco Gelpi discusses surgical treatments for BPH with a special focus on the minimally-invasive GreenLight Laser prostatectomy. Listen to hear more about Dr. Gelpi’s transition from an oncology-focused practice to a BPH-focused practice, initial BPH patient workup , using prostate anatomy to choose a BPH surgical treatment, GreenLight Laser postoperative care, and the importance of BPH patient involvement and expectations.
Dr. Aditya Bagrodia interviews urologist Dr. Steve Hudak from UT Southwestern Medical Center about post-prostatectomy incontinence. They cover an array of topics including, incontinence evaluation, managing patient expectations, kegel exercises and pelvic floor therapy, and slings vs. artificial urinary sphincters.
Urinary Incontinence Treatment
Treatment and management of incontinence varies with the type of urinary incontinence. For stress urinary incontinence, behavioral therapy, electrical stimulation, and pelvic floor muscle strengthening are common forms of conservative management while alpha-adrenergic agonists are used as a pharmaceutical therapy. Surgical management consists of intravesical balloons, sling procedures, or urethropexy. Urge urinary incontinence does not use mechanical devices, but is otherwise managed similar to stress incontinence. Antimuscarinics are used for pharmacological management. Overflow urinary incontinence is treated with clean intermittent catheterization, alpha-adrenergic antagonists, or a suprapubic catheter. To treat functional urinary incontinence, underlying cognitive causes should be addressed.
 Tran, L. N., & Puckett, Y. (2021, August 11). Urinary incontinence. StatPearls [Internet]. Retrieved November 10, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK559095/
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