Urinary incontinence

Question 1

Antimuscarinic meds for urge incontinence

Answer 1

Oxybutynin
Tolerodine
Solifenacin

MOA: block parasympathetic M2/M3 receptors and involuntary detrusor contraction

S/e: dry eye/mouth

Contraindications: narrow angle glaucoma, urinary retention, gastric retention/obstructive disorder

Question 2

Beta 3 adrenoreceptor agonist

Answer 2

mirabegron

MOA: relaxes detrusor and increases capacity

S/e: tachycardia, headache, diarrhea

Contraindication: uncontrolled severe HTN, severe renal or liver disease

Question 3

Botox for urge incontinence
- dose
- s/e
- effectiveness vs antimuscarinics

Answer 3

onabolulinum toxin A
100 u intravesical q 6 months

s/e: uti, retention

more patients have complete resolution but have similar decrease in UI episodes vs antimuscarinics

Question 4

Does systemic HRT help with incontinence?

Answer 4

no. topical estrogen may reduce them though.

Question 5

Behavioral modifications

Answer 5

help with both kinds of incontinence

Pelvic floor exercises (w or w/o PT)
Weight loss
Bladder training
Diet/fluid modification
Devices e.g. pessary

Question 6

SUI surgery

Answer 6

urethral bulking agents - better for pts with lack of urethral mobility since these patients are 2x more likely to fail MUS

MUS

Question 7

UUI management

Answer 7

SACRAL NEUROMODULATION