0521779407-21 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:59
1494 Urinary Incontinence■Transient urinary incontinence (common in the elderly, especially
when hospitalized)management
What to Do First
■Exclude urinary tract infection.
■Verify proper bladder emptying (uroflow and post-void residual).
■Exclude neurologic disease.
■General measures
➣Adjust fluid intake if excessive.
➣Teach pelvic floor exercises (Kegel).
➣Consider biofeedback.
➣Medical therapy
Alpha-agonist medication to increase outlet resistance
Anticholinergic drugs for urge incontinence
➣Local and/or systemic hormonal replacementspecific therapy
Pseudo-Incontinence
■Transvaginal excision of urethral diverticulum
■Vaginal voiding (spread labia or legs wide during voiding)Stress Incontinence Not Responding to Nonsurgical Options
■Surgical Treatment Options
➣Periurethral injection therapy (collagen, fat, others)
➣Vaginal surgery to restore proper urethral support
➣Abdominal surgery (Burch-type procedure)
➣Sling (source: autologous, synthetic, or cadaver tissue)Urge Incontinence
■Nonsurgical Treatment Options
➣Anticholinergic medications: Ditropan and Detrol are the most
common drugs prescribed because they have the longest track
record, but many new medications have entered the market in
recent years: Vesicare, Sanctura, Enablex.
➣Timed voiding
■Surgical Treatments
➣New research drugs administered intravesically (capsaicin,
resiniferatoxin, BoTox (B toxin)
➣Open abdominal surgery (augmentation cystoplasty)