W3L2 Male Incontinence

Question 1

Type & cause?

Answer 1

1. Urgency urinary incontinence
2. Stress incontinence
3. Nocturnal enuresis
4. Postmicturition dribble
5. Functional incontinence
6. False (overflow) incontinence

Question 2

Diagnosis?

Answer 2

I. History

• LUTS
• Neurological disease
• Previous prostate surgery/pelvic rt
• Drug intake
• Trauma

II. Examination

• Neurological examination
• Abdominal examination
  
  • Scar of previous prostate surgery
  • Full bladder
• DRE
  
  • Analtone,bulbocavernosalreflex
  • BPH,prostatecancer

III. Investigation

• Urine analysis & culture to exclude UTI
• Uroflowmetry & Post-voiding residual urine
• Voiding cystourethrogram(VCUG)
• Urodynamic study(UDS)
• Cystoscopy

Question 3

Ttt

Answer 3

1. Overactive bladder (OAB)
   
   • Behavioral therapy
   • Anti-muscarenics
   • Electrical stimulation
   • Intradetrusal Botox injection
   • Surgery
2. Stress incontinence (Post prostatectomy incontinence (PPI))
   
   • Pelvic floor muscle exercise
   • Bulbourethral sling
   • Artificial urinary sphincter (AUS)
3. Nocturnal enuresis
   
   • Behavioral therapy
   • Vasopressin(ADH)
4. Benign prostatic hyperplasia (BPH)
   
   • Pharmacotherapy(Alpha blocker)
   • Surgery(TURP)
5. Functional incontinence
   
   • Condom/Indwelling Catheter