Campbell-Walsh Urology, 11th Edition

PART XII

Urine Transport, Storage, and Emptying

72

Evaluation and Management of Men with Urinary Incontinence

Hashim Hashim; Paul Abrams

Questions

1. Which of the following is the definition of stress urinary incontinence?
2. Leakage of urine with urgency
3. Leakage of urine with an increase in intra-abdominal pressure
4. Leakage of urine while asleep
5. Leakage of urine with urgency and effort
6. Leakage of urine without being aware of it
7. Initial assessment of men with urinary incontinence includes all of the following EXCEPT:
8. flow test.
9. invasive urodynamics.
10. frequency/volume chart.
11. urinalysis.
12. quality-of-life questionnaire.
13. Which of the following is NOT a treatment for urgency urinary incontinence (UUI)?
14. Bladder training
15. Pelvic floor muscle training
16. Antimuscarinics
17. Duloxetine
18. Botox
19. Which of the following is NOT a treatment for stress urinary incontinence in men?
20. Pelvic floor muscle training
21. Penile clamp
22. Antimuscarinics
23. Male sling
24. Artificial urinary sphincter
25. Which of the following is NOT measured by the International Prostate Symptom Score (AUA-SI)?
26. Urgency
27. Frequency
28. Nocturia
29. Incontinence
30. Straining

Answers

1. b. Leakage of urine with an increase in intra-abdominal pressure.Leakage of urine with urgency is known as urgency urinary incontinence. Leakage of urine while asleep is nocturnal enuresis. Leakage of urine on urgency and effort is mixed urinary incontinence, and leakage of urine without being aware of it is insensible urinary incontinence.
2. b. Invasive urodynamics. Men with urinary incontinence should be assessed with noninvasive baseline investigations including a flow test, frequency/volume chart or bladder diary, urinalysis to exclude infection and blood in the urine, and a quality-of-life questionnaire to assess the impact of the incontinence on quality of life.Invasive urodynamics, including filling cystometry and pressure flow studies, is reserved after failure of conservative and medical therapies and when it will alter the management of the patient.
3. d. Duloxetine.Bladder training, pelvic floor muscle training, and antimuscarinics are first-line treatments of patients with UUI. If these fail, then patients can be treated with cystoscopic intra-detrusor botulinum toxin-A injections. Duloxetine is a serotonin, norepinephrine reuptake inhibitor that has been licensed for the treatment of stress urinary incontinence in women, and not UUI.
4. c. Antimuscarinics.Antimuscarinics are licensed for the treatment of overactive bladder syndrome and not stress urinary incontinence.
5. d. Incontinence. The IPSS or American Urological Association Symptom Index assesses three storage symptoms (urgency, frequency, nocturia), three voiding symptoms (intermittency, weak stream, straining), and one postmicturition symptom (incomplete emptying). It does not assess for urinary incontinence.

Chapter review

1. In men, stress incontinence is usually a consequence of prostatectomy.
2. When enuresis occurs later in life, one should suspect high-pressure chronic urinary retention.
3. A 3-day bladder diary is extremely useful in evaluating urinary incontinence.
4. Patients receiving Botox should be warned of the risk of urinary retention and the possible need for intermittent catheterization.
5. Postmicturition incontinence is treated by pelvic floor muscle training and urethral milking.
6. Men with urinary incontinence should be assessed with non-invasive baseline investigations including a flow test, frequency/volume chart or bladder diary, urinalysis to exclude infection and blood in the urine, and a quality of life questionnaire to assess the impact of the incontinence on quality of life.
7. The IPSS or AUA-SI assesses three storage symptoms (urgency, frequency, nocturia), three voiding symptoms (intermittency, weak stream, straining), and one post-micturition symptom (incomplete emptying).