Urology- Incontinence

Question 1

Causes of incontinence: urethral obstruction

Answer 1

BPH, strictures, stenosis

Question 2

Causes of incontinence: impair bladder contraction

Answer 2

DM, MS, spinal injuries, detrusor hyperactivity

Question 3

Causes of incontinence: incompetent sphincter

Answer 3

stress incontinence, cystocele

Question 4

Causes of incontinence: bladder inflammation

Answer 4

UTI, interstitial cystitis

Question 5

Causes of incontinence: bladder stones

Answer 5

obstruction, metabolic disease, UTI

Question 6

Causes of incontinence: malignancy

Answer 6

bladder cancer, carcinoma in situ, invasive cancer

Question 7

Urge incontinence/OAB

Answer 7

involuntary leakage of urine, involuntary contraction of bladder, detrusor hyperreflexia

Question 8

Stress incontinence

Answer 8

Involuntary leakage with “stress”

cystitis, stones, tumor, neurologic

Question 9

Overflow incontinence

Answer 9

leaking urine throughout the day
“Weight of urine”

Question 10

Meds for OAB

Answer 10

Smooth muscle relaxants
Beta-3 adrenergic receptor agonists

Question 11

Smooth muscle relaxants MoA

Answer 11

Antimuscarinic, “atropine”-like

Question 12

Smooth muscle relaxants drugs

Answer 12

Oxybutinin, tolterodine, trospium, darifenacin, solifenacin, fesoterodine

Question 13

Most effective smooth muscle relaxants

Answer 13

Darifenacin, solifenacin, ER tolterodine –> least likely to cause side effects!

Question 14

Beta-3 adrenergic receptor agonists MoA

Answer 14

Detrusor muscle relaxation –> works on the storage phase

Question 15

Beta-3 adrenergic receptor agonist drugs

Answer 15

Myrbetriq, Gemtesa

Question 16

Which beta-3 adrenergic receptor agonist is preferred and why?

Answer 16

Gemtesa, because it doesn’t have the ADE of HTN

Question 17

Mybetriq ADEs

Answer 17

Nausea, HA, HTN, diarrhea, constipation, dizziness, sinus tachycardia

Question 18

Gemtesa ADEs

Answer 18

Nausea, HA, diarrhea, constipation, nasopharyngitis, bronchitis, URI, UTI

Question 19

Stress incontinence treatments

Answer 19

Alpha-receptor antagonist
Estrogen replacement

Question 20

Alpha-receptor agonist MoA

Answer 20

Increase intra-urethral pressure

Question 21

Estrogen replacement MoA

Answer 21

Causes proliferation of urethral mucosa

Question 22

Alpha-receptor agonist drugs

Answer 22

Pseudoephedrine, midodrine

Question 23

Pseudoephedrine ADEs

Answer 23

Insomnia, HTN, tremor, palpitations

Question 24

Estrogen ADEs

Answer 24

Pap/mammogram results get skewed, bleeding, DVT

Question 25

Overflow incontinence drug

Answer 25

Bethanechol

Question 26

Bethanechol MoA

Answer 26

Stimulates muscarinic receptors, bladder tone

Question 27

Bethanechol ADEs

Answer 27

GI cramping/diarrhea/salivation, orthostasis with reflex tachycardia, urgency, bronchial constriction

Question 28

Medications affecting continence

Answer 28

alpha-agonists/antagonists, alcohol, anticholinergics, cholinesterase inhibitors, CCBs, diuretics, narcotics, ADs, APS, sedative/hypnotics

Question 29

Nonpharm treatment for incontinence

Answer 29

Behavioral therapies (bladder training, bladder control strategies, pelvic floor muscle training, fluid management)

Question 30

AUA Guidelines on OAB: 1st line treatment

Answer 30

Nonpharm treatments, behavioral therapy

Question 31

AUA Guidelines on OAB: 2nd line treatment

Answer 31

PO antimuscarinics or PO beta-3-agonists

Use a combo of these if refractory to monotherapy

Question 32

Avoid antimuscarinics in…

Answer 32

Narrow-angle glaucoma, extreme caution in decreased gastric emptying or urinary retention