Podcast
Questions and Answers
Which of the following is NOT a reversible cause of urinary incontinence according to the text?
Which of the following is NOT a reversible cause of urinary incontinence according to the text?
What is example of one of the recommended first-line treatment for urinary incontinence based on the provided text?
What is example of one of the recommended first-line treatment for urinary incontinence based on the provided text?
When evaluating a patient with sudden or acute onset of severe urinary symptoms, what should always be considered as a potential source according to the text?
When evaluating a patient with sudden or acute onset of severe urinary symptoms, what should always be considered as a potential source according to the text?
What type of urinary incontinence is due to a temporary illness that can be reversed?
What type of urinary incontinence is due to a temporary illness that can be reversed?
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Which of the following is NOT mentioned as a common pharmaceutical cause of reversible urinary incontinence?
Which of the following is NOT mentioned as a common pharmaceutical cause of reversible urinary incontinence?
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What type of treatment is ineffective for functional incontinence according to the text?
What type of treatment is ineffective for functional incontinence according to the text?
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Which muscle overactivity is the cause of urge incontinence?
Which muscle overactivity is the cause of urge incontinence?
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What are the common symptoms associated with an overactive bladder?
What are the common symptoms associated with an overactive bladder?
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Which class of drugs is considered the first-line pharmaceutical treatment for urge incontinence?
Which class of drugs is considered the first-line pharmaceutical treatment for urge incontinence?
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Why are anticholinergic drugs not recommended for patients with uncontrolled narrow-angle glaucoma?
Why are anticholinergic drugs not recommended for patients with uncontrolled narrow-angle glaucoma?
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Which category of medications can cause cognitive impairment in the elderly population?
Which category of medications can cause cognitive impairment in the elderly population?
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What is the first-line pharmaceutical treatment for urge incontinence that acts as a smooth muscle relaxer?
What is the first-line pharmaceutical treatment for urge incontinence that acts as a smooth muscle relaxer?
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Which second-line pharmaceutical therapy for urge incontinence increases the risk of urinary retention and/or UTIs?
Which second-line pharmaceutical therapy for urge incontinence increases the risk of urinary retention and/or UTIs?
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What is the grade for the use of anticholinergic drugs in pregnancy?
What is the grade for the use of anticholinergic drugs in pregnancy?
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What is a common risk factor for developing stress incontinence?
What is a common risk factor for developing stress incontinence?
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Which type of surgery is considered the most effective and definitive treatment for stress incontinence?
Which type of surgery is considered the most effective and definitive treatment for stress incontinence?
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Which population is more likely to develop stress incontinence according to the text?
Which population is more likely to develop stress incontinence according to the text?
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Which medication has shown improvement in symptoms for stress incontinence but cannot be used in patients with tachyarrhythmias or hyperthyroidism?
Which medication has shown improvement in symptoms for stress incontinence but cannot be used in patients with tachyarrhythmias or hyperthyroidism?
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What is the main diagnostic criterion for identifying stress incontinence, besides patient history?
What is the main diagnostic criterion for identifying stress incontinence, besides patient history?
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Which treatment modality for stress incontinence aims to improve pelvic muscle strength?
Which treatment modality for stress incontinence aims to improve pelvic muscle strength?
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Why are oral estrogens not recommended for women with urinary incontinence?
Why are oral estrogens not recommended for women with urinary incontinence?
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Which class of drugs has been shown to worsen stress incontinence?
Which class of drugs has been shown to worsen stress incontinence?
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Which medication has shown effectiveness in treating stress incontinence but has contraindications for patients with a history of withdrawal syndrome?
Which medication has shown effectiveness in treating stress incontinence but has contraindications for patients with a history of withdrawal syndrome?
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What type of surgery is considered the main surgical treatment for stress incontinence?
What type of surgery is considered the main surgical treatment for stress incontinence?
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Which of the following is a known side effect of alpha-adrenergic agonists used to manage stress incontinence?
Which of the following is a known side effect of alpha-adrenergic agonists used to manage stress incontinence?
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What lifestyle modification is recommended for managing stress incontinence?
What lifestyle modification is recommended for managing stress incontinence?
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Stress incontinence can occur from:
Stress incontinence can occur from:
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Stress incontinence is rare in men, except in the case of:
Stress incontinence is rare in men, except in the case of:
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What is a common cause of overflow incontinence?
What is a common cause of overflow incontinence?
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What should be checked in patients with overflow incontinence and a post-residual volume greater than 350 mL?
What should be checked in patients with overflow incontinence and a post-residual volume greater than 350 mL?
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Which of the following is a treatment option for overflow incontinence?
Which of the following is a treatment option for overflow incontinence?
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What is a characteristic of patients with overflow incontinence regarding bladder emptying?
What is a characteristic of patients with overflow incontinence regarding bladder emptying?
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In patients with acute obstruction and overflow incontinence, what initial intervention is recommended for decompression?
In patients with acute obstruction and overflow incontinence, what initial intervention is recommended for decompression?
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When should a patient be referred to a specialist for possible urinary incontinence due to suspected vesicovaginal fistula?
When should a patient be referred to a specialist for possible urinary incontinence due to suspected vesicovaginal fistula?
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What should be considered when evaluating a patient with recurrent culture-proven UTIs?
What should be considered when evaluating a patient with recurrent culture-proven UTIs?
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What is an indicator for possible referral to a specialist in cases of urinary incontinence?
What is an indicator for possible referral to a specialist in cases of urinary incontinence?
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Which symptom, in addition to urinary incontinence, may trigger a referral to a specialist?
Which symptom, in addition to urinary incontinence, may trigger a referral to a specialist?
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What condition may prompt the need for referral to a specialist in cases of urinary incontinence?
What condition may prompt the need for referral to a specialist in cases of urinary incontinence?
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Which diagnostic finding indicates a cystocele?
Which diagnostic finding indicates a cystocele?
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What is a common risk factor for developing a cystocele?
What is a common risk factor for developing a cystocele?
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What is the definitive diagnosis for a urethral stricture?
What is the definitive diagnosis for a urethral stricture?
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What initial test is often used to diagnose a urethral stricture?
What initial test is often used to diagnose a urethral stricture?
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What is indicated if a patient with a urethral stricture has bothersome urinary complications?
What is indicated if a patient with a urethral stricture has bothersome urinary complications?
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Which surgical intervention is commonly performed for a cystocele?
Which surgical intervention is commonly performed for a cystocele?
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What is a common symptom reported by patients with a cystocele?
What is a common symptom reported by patients with a cystocele?
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What is the main symptom that a patient with a Urethral Stricture is likely to complain about?
What is the main symptom that a patient with a Urethral Stricture is likely to complain about?
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Which of the following conditions can lead to urethral stricture formation?
Which of the following conditions can lead to urethral stricture formation?
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What is a common complication of urethral strictures?
What is a common complication of urethral strictures?
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How are cystoceles graded based on the text?
How are cystoceles graded based on the text?
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Which of the following is a common complaint in patients with a cystocele
Which of the following is a common complaint in patients with a cystocele
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What is considered the gold standard for the diagnosis and staging of bladder cancer?
What is considered the gold standard for the diagnosis and staging of bladder cancer?
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Which population is at the greatest risk for bladder cancer?
Which population is at the greatest risk for bladder cancer?
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What is the most common complaint associated with bladder cancer?
What is the most common complaint associated with bladder cancer?
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What is recommended for relief of symptoms in patients with interstitial cystitis?
What is recommended for relief of symptoms in patients with interstitial cystitis?
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What is the main characteristic of interstitial cystitis?
What is the main characteristic of interstitial cystitis?
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What is a major risk factor for bladder cancer?
What is a major risk factor for bladder cancer?
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Chronic indwelling catheters are indicated for Incomplete bladder emptying, Neurogenic bladder, Urethral stricture, Urinary Retention
Chronic indwelling catheters are indicated for Incomplete bladder emptying, Neurogenic bladder, Urethral stricture, Urinary Retention
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Study Notes
Urinary Incontinence
- Defined as the involuntary loss of urine
- Reversible causes include: infection, atrophic vaginitis, bladder irritants, and pharmaceutical causes
- Common pharmaceutical causes: antihistamines, decongestants, benzodiazepines, opioids, diuretics, alpha-blockers, and anti-arrhythmic
Urge Incontinence (OAB)
- Defined as the leakage of urine preceded by a strong urge to void with the inability to delay urination
- Caused by the overactivity of the detrusor muscle
- Symptoms: urinary urgency, frequency, and/or nocturia
- First-line treatment: non-pharmaceutical lifestyle modifications and pelvic floor physical therapy
- Pharmaceutical treatment: anticholinergic drugs (e.g. oxybutynin) and beta-3 agonists (e.g. mirabegron)
- Anticholinergic drugs: adverse effects include dry mouth, constipation, blurred vision, tachycardia, and orthostatic hypotension
Stress Incontinence
- Defined as urinary leakage secondary to increased intra-abdominal pressure
- Causes: laxity of the pelvic floor muscles
- Risk factors: obesity, multiple vaginal deliveries, and radical prostatectomy in men
- Diagnosis: patient history and physical exam findings of urine leakage with coughing on a full bladder
- Treatment: lifestyle modifications, pelvic floor physical therapy, insertable devices (e.g. pessaries), and surgery (midurethral sling)
Overflow Incontinence
- Defined as urinary incontinence due to urinary retention leading to incomplete bladder emptying
- Causes: underactive bladder, decreased detrusor muscle activity, bladder outlet obstructions (e.g. BPH or urethral stricture)
- Treatment: dependent on pathology, may include catheterization, 5-alpha-reductase inhibitors, and alpha-1 adrenergic blockers
Referral to a Specialist
- Indications for referral: suspected surgical candidate for SUI, associated abdominal/pelvic pain, recurrent UTI, gross/microscopic hematuria, and suspected overflow incontinence
Pelvic Organ Prolapse - Cystocele
- Defined as the posterior bladder herniating into the anterior vagina
- Risk factors: weakness in pelvic floor, increased pelvic floor pressure, multiple vaginal deliveries, obesity, age, and menopause
- Symptoms: pelvic and/or vaginal fullness
- Diagnosis: physical exam findings of a bulging mass from the vagina with increased abdominal pressure
- Treatment: pelvic floor therapy, pessaries, topical estrogen, or surgical interventions (e.g. hysterectomy, uterosacral/sacrospinous ligament fixation)
Urethral Stricture
- Defined as a narrowing or complete blockage of the urethra secondary to scar tissue formation
- Causes: traumatic injuries, penile fractures, catheters, UTIs
- Symptoms: weak stream, urinary dribbling, urinary spraying, or a split urinary stream
- Diagnosis: retrograde urethrogram (RUG) or cystourethroscopy
- Treatment: minimally invasive dilations, urinary diversion with tubes, or surgical reconstruction of the urethra
Bladder Cancer
- Risk factors: smoking, white males
- Most common complaint: painless gross or microscopic hematuria
- Diagnosis: cystoscopy with biopsy
- Treatment: transurethral resection of the bladder tumor (TURBT) for early-stage tumors
Interstitial Cystitis
- Defined as chronic bladder pain in the absence of other explanatory etiologies
- Symptoms: greater than 6 weeks of pain and discomfort related to bladder filling, but relieved with bladder emptying
- Treatment: Amitriptyline for symptom relief, no curative treatment
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Description
Test your knowledge on reversible causes of urinary incontinence, including infections, atrophic vaginitis, bladder irritants, and common pharmaceuticals that can lead to this condition. Explore the factors that can contribute to involuntary loss of urine.
