Bladder and urinary disorders

Question 1

Urinary incontinence: treatment (women)

Answer 1

Urge incontinence:

• First line: Bladder training - 6 weeks →
• Antimuscarinic drugs (oxybutynin, tolterodine) →
• Mirabegron

Stress incontinence:

• First line: pelvic floor training - 3M →
• Duloxetine

Question 1

Urinary incontinence: drugs

Answer 1

Antimuscarinics

• Oxybutynin (available as transdermal patch)
• Tolterodine
• Solifenacin

Beta3 agonist

• Mirabegron (CI: severe uncontrolled HT)

Other

• Duloxetine (SNRI, avoid abrupt withdrawal)

Question 2

Nocturnal enuresis: treatment 5+ years

Answer 2

First line: enuresis alarms (continue til 2 weeks of dry nights) →

Desmopressin (oral or sublingual)

• Counsel: avoid fluid overload (inc swimming), restrict fluid intake 1h before + 8h after
• Stop desmopressin if vomiting or diarrhoea

Question 3

Urinary retention: treatment

Answer 3

• Alpha blockers
• 5a-reductase inhibitors (raised prostate specific antigen + high risk of progression)

Question 4

Alpha blocker: MOA

Answer 4

blocks alpha 1 adrenoreceptors; relaxes bladder + prostate gland

Question 5

Alpha blocker: indication

Answer 5

• Benign prostatic hyperplasia
• Hypertension

Question 6

Alpha blocker: drugs

Answer 6

• Alfuzosin (BPH only)
• Tamsulosin (BPH only)
• Doxazosin

Question 7

Alpha blocker: side effect

Answer 7

Postural hypotension
- Dizzy, blurred vision, fainting, tachycardia
- Counsel: take first dose at bedtime, driving can be impaired
- CI: postural hypotension

Question 8

Finasteride/dutasteride: MOA

Answer 8

5a reductase inhibitor; prevents metabolism of testosterone into dihydrotestosterone

Question 9

Finasteride/dutasteride: indication

Answer 9

• Benign prostatic hyperplasia
• Male pattern baldness

Question 10

Finasteride/dutasteride: side effect

Answer 10

Male breast cancer
- Counsel: report breast symptoms (breast pain, lumps, nipple discharge)

Finasteride: Suicidal thoughts + ED
- MHRA: reminder of risk of psychiatric + sexual side effects, patient alert card
- Counsel: stop and report depression
- Counsel: report sexual dysfunction (inability to get or maintain erection, reduced sex drive)

Question 11

Finasteride/dutasteride: pregnancy

Answer 11

Teratogenic