Overview
How common is urinary incontinence?
What are the types of urinary incontinence?
How is urinary incontinence diagnosed?
What is the focus of clinical history for the evaluation of urinary incontinence?
Which medical problems may complicate or exacerbate urinary incontinence?
Which medications are associated with urinary incontinence?
Which therapies are used to treat urinary incontinence?
When are absorbent products indicated in the treatment of urinary incontinence treatment?
Which medications are used in the treatment of urinary incontinence?
Which surgical techniques are used to treat urinary stress incontinence?
Which surgical techniques are used to treat urinary urge incontinence?
How is urinary incontinence categorized?
What are terms used in describing urinary incontinence?
How does the treatment of urinary incontinence vary by type?
Which factors have increased attention to urinary incontinence?
What are the costs of urinary incontinence?
What anatomy is relevant to urinary incontinence?
What is the pathophysiology of urinary incontinence?
What is the pathophysiology of stress urinary incontinence?
What is the role of urethral hypermobility in the pathophysiology of urinary incontinence?
What is the role of intrinsic sphincter deficiency in the pathophysiology of urinary incontinence?
What is the pathophysiology of occult stress urinary incontinence?
What is the pathophysiology of urge urinary incontinence?
What is the role of detrusor overactivity in urge urinary incontinence pathophysiology?
What is the pathophysiology of urge urinary incontinence in men?
What is the role of bladder inflammation in urge urinary incontinence pathophysiology?
What is the pathophysiology of mixed urinary incontinence?
What is the pathophysiology of reflex urinary incontinence?
What is the pathophysiology of overflow urinary incontinence?
What is the pathophysiology of functional urinary incontinence?
What is the integral theory of urinary incontinence in women?
What is the pathophysiology of continuous urinary incontinence?
What is the pathophysiology of pediatric urinary incontinence?
What causes urinary incontinence?
What are the transient causes of urinary incontinence?
What are the neurological causes of urinary incontinence?
What are the pharmacologic causes of urinary incontinence?
What is the prevalence of urinary incontinence?
Which patient groups have the highest prevalence of urinary incontinence?
What are the racial predilections of urinary incontinence?
What is the prognosis of urinary incontinence?
What is the medical morbidity associated with urinary incontinence?
What is the psychological morbidity associated with urinary incontinence?
What are the complications of untreated urinary incontinence?
What is the impact of urinary incontinence in elderly persons?
What is included in patient education about urinary incontinence?
Presentation
What are the major types of urinary incontinence?
How should a history of urinary incontinence be elicited?
Which clinical history findings are characteristic of urinary incontinence?
Which medical conditions complicate or exacerbate urinary incontinence?
Which medications are associated with urinary incontinence?
What is the role of questionnaires in the evaluation of urinary incontinence?
What is the role of a voiding diary in the evaluation of urinary incontinence?
What is the pace of onset characteristic of urinary incontinence?
What is stress urinary incontinence?
What is urge urinary incontinence?
What is mixed urinary incontinence?
What is overflow urinary incontinence?
What is included in the physical exam for urinary incontinence?
What is included in the neurological exam for urinary incontinence?
How is the pelvic exam for urinary incontinence performed?
What is the cotton swab test for urinary incontinence?
What is the role of a pad test in the assessment of urinary incontinence?
What is a paper towel test for urinary incontinence?
What is the role of a cough stress test in the evaluation of urinary incontinence?
When is a standing cough stress test indicated in the evaluation of urinary incontinence?
What is the role of the Marshall test in the evaluation of urinary incontinence?
DDX
Which conditions are included in the differential diagnoses of urinary incontinence?
What are the differential diagnoses for Urinary Incontinence?
Workup
How is urinary incontinence diagnosed?
Which factors improve diagnostic accuracy of urinary incontinence?
What is the role of the emergency physician in urinary incontinence diagnosis?
Which basic tests are performed in the emergency department (ED) workup for urinary incontinence?
What is the role of imaging studies in the workup of urinary incontinence?
What is the role of urinalysis and urine culture in the workup of urinary incontinence?
What is the role of urine cytology in the workup of urinary incontinence?
What is the role of diabetes testing in the workup of urinary incontinence?
What is the role of urodynamic testing in the workup of urinary incontinence?
What is the role of chain-bead cystography in the workup of urinary incontinence?
What is the role of postvoid residual volume measurement in the workup of urinary incontinence?
What is the role of cystoscopy and urethroscopy in the workup of urinary incontinence?
What is the role of a pessary trial in the workup of urinary incontinence?
What is the role of MRI in the workup of urinary incontinence?
What is the role of ultrasonography in the workup of urinary incontinence?
What is the role of renal function studies in the workup of urinary incontinence?
Treatment
How is urinary incontinence treated?
What is the role of absorbent products in urinary incontinence treatment?
What are the criteria for use of absorbent products in the treatment of urinary incontinence?
When are absorbent products contraindicated in the treatment of urinary incontinence?
What types of absorbent products are used in the treatment of urinary incontinence?
What is the role of urethral occlusion devices in urinary incontinence treatment?
What is the role of catheterization in urinary incontinence treatment?
What is the role of indwelling urethral catheters in the treatment of urinary incontinence?
What are the symptoms of bladder infection from catheters for urinary incontinence?
How are bladder infection from catheters for urinary incontinence prevented?
What are the disadvantages of Foley catheters for urinary incontinence prevented?
What is the role of suprapubic catheters in urinary incontinence treatment?
When is a suprapubic catheter indicated in urinary incontinence treatment?
What are advantages of suprapubic catheters in urinary incontinence treatment?
What are the possible complications of suprapubic catheters in urinary incontinence treatment?
What is the role of intermittent catheterization in urinary incontinence treatment?
What are the advantages of intermittent catheterization for urinary incontinence treatment?
What is the role of self-catheterization in urinary incontinence treatment?
What is the role of medicated and silver-coated catheters in urinary incontinence treatment?
Which medications are used for urinary incontinence treatment?
What is the role of alpha agonists in urinary incontinence treatment?
What is the role of tricyclic antidepressants (TCAs) in urinary incontinence treatment?
What is the role of duloxetine in urinary incontinence treatment?
What is the role of anticholinergic agents in urinary incontinence treatment?
What is the role of darifenacin (Enablex) in urinary incontinence treatment?
What is the role of fesoterodine (Toviaz) in urinary incontinence treatment?
What is the role of antispasmodic drugs in urinary incontinence treatment?
What is the role of calcium channel blockers in urinary incontinence treatment?
What is the role of beta-adrenergic agonists in urinary incontinence treatment?
What is the role of estrogen therapy in urinary incontinence treatment?
What is the role of botulinum toxin in urinary incontinence treatment?
What is the role of intravesical pharmacotherapy in urinary incontinence treatment?
What is the role of potassium channel openers in urinary incontinence treatment?
What is the role of prostaglandin in urinary incontinence treatment?
What is the role of patient-derived adipose stem cells (ASCs) in urinary incontinence treatment?
How is nocturnal enuresis treated in urinary incontinence?
How is nighttime voiding treated in urinary incontinence?
What is the role of pelvic floor rehabilitation in urinary incontinence treatment?
Which patients benefit from pelvic floor muscle training for urinary incontinence?
Which treatments may be combined with pelvic floor muscle training for urinary incontinence?
What is the role of vaginal cones in urinary incontinence treatment?
What is the role of biofeedback in urinary incontinence treatment?
What is the role of electrical stimulation in urinary incontinence treatment?
What is the role of acupuncture in urinary incontinence treatment?
What is the role of extracorporeal magnetic resonance therapy in urinary incontinence treatment?
What is the role of weight loss in urinary incontinence treatment?
What is the role of behavioral therapy in urinary incontinence treatment?
What is the efficacy of bladder training for urinary incontinence?
When is surgery indicated to treat urinary incontinence?
What is the role of surgery in the treatment of stress urinary incontinence in women?
What is the role of surgery in the treatment of stress urinary incontinence in men?
What is the role of surgery in the treatment of urge urinary incontinence?
Which dietary modifications are used in the treatment of urinary incontinence?
Which fluid intake modifications are used in urinary incontinence treatment?
Which specialist consultations are beneficial to patients with urinary incontinence?
When is emergency department (ED) care indicated in urinary incontinence treatment?
Medications
What is the role of medications in urinary incontinence treatment?
Which medications in the drug class Estrogens are used in the treatment of Urinary Incontinence?
-
Urinary incontinence. Normal findings on urodynamic study of a 35-year-old white man. During the filling cystometrogram (CMG), there is absence of uninhibited detrusor contractions. Bladder compliance is normal. His maximum bladder capacity is 435 mL. During the pressure-flow study, his maximum flow rate (Qmax) is 25 mL/s and detrusor pressure at maximum flow rate (Pdet Qmax) is 50 cm H2O. The uroflow pattern is without abnormality, producing a bell-shaped curve without any abdominal straining. He voids to completion, and the postvoid residual urine is negligible.
-
Urinary incontinence. Urodynamic study revealing detrusor instability in a 75-year-old man with urge incontinence. Note the presence of multiple uninhibited detrusor contractions (phasic contractions) that is generating 40- to 75-cm H2O pressure during the filling cystometrogram (CMG). He also has small bladder capacity (81 mL), which is indicative of poorly compliant bladder.
-
Urinary incontinence. Urodynamic study revealing detrusor hyperreflexia in a 22-year-old woman with multiple sclerosis. Note the presence of multiple phasic contractions (uninhibited detrusor contractions) generating as much as 100 cm H2O pressure.
-
Urinary incontinence. Urodynamic recording of bladder outlet obstruction due to benign prostatic hyperplasia (BPH) in a 55-year-old man. Note that during a pressure-flow study, his maximum flow rate (Qmax) is only 6 mL/s and detrusor pressure at maximum flow rate (Pdet Qmax) is very high at 101 cm H2O. He also has a small bladder capacity (50 mL) due to chronic bladder outlet obstruction. His flow curve is flat and "bread-loaf" in pattern, which is consistent with infravesical obstruction.
-
Urinary incontinence. Urodynamic study revealing detrusor sphincter dyssynergia in a 35-year-old woman with C5 spinal cord injury. Note the absence of uninhibited detrusor contractions during the filling cystometrogram (CMG). Typically, patients with cervical cord lesions manifest detrusor hyperreflexia. However, this patient is taking Ditropan XL. Thus, phasic contractions are suppressed. During the pressure-flow study, note the increase in amplitude of the electromyogram (EMG) coincident with detrusor contraction and voiding. Her uroflow rate is low (1 mL/s), detrusor pressure is high (42 cm H2O), and the EMG recording is elevated.
-
Urinary incontinence. Video-urodynamic study illustrating type III stress urinary incontinence (intrinsic sphincter deficiency [ISD]) in a 65-year-old woman. Static cystogram reveals obvious contrast leakage via the urethra during Valsalva maneuver. Urodynamic study records abdominal leak point pressure (ALPP) of 55 cm H2O, consistent with ISD.
-
A cystoscopic view of the bladder mucosa reveals shallow ulcerations and petechial hemorrhages, which are findings consistent with interstitial cystitis.
-
A cotton swab angle greater than 30° denotes urethral hypermobility. Figure 1 shows that the cotton swab at rest is zero with respect to the floor. Figure 2 shows that the cotton swab at stress is 45° with respect to the floor.
-
A squirt of urine is observed at the peak of an increase in intra-abdominal pressure in a supine patient
-
This photo illustrates a variety of pelvic organ prolapses, including grade-IV cystocele, uterine descensus, enterocele, and rectocele alone or in combination. In situations where a significant prolapse (eg, uterus, bladder) has occurred, evaluate for possible ureteral obstruction at the level of the pelvic inlet.