~urinary incontinence... - pindi

[ArchivalUser]

A 63-year-old man is evaluated for urinary incontinence characterized by leaking, dribbling urine, occurring throughout the day and requiring him to wear pads. His symptoms of incontinence began after he underwent radical prostatectomy 3 years ago for prostate cancer, and they have persisted since then. Treatment with tolterodine has not been helpful. He works as a businessman and travels frequently and states that his symptoms are beginning to interfere with performance of his daily activities. His medical history also includes depression, for which takes sertraline.

On physical examination, there are no palpable prostatic or rectal masses. The remainder of the physical examination is normal. The serum prostate-specific antigen level is undetectable.

Which of the following is the most appropriate next step in treatment?

A Discontinue sertraline
B Begin oxybutynin
C Institute behavioral therapy
D Perform bulbourethral sling procedure

[ArchivalUser]

Ans d

[ArchivalUser]

and is d

[ArchivalUser]

uretrovesical valve is lost
so d

[ArchivalUser]

~ Correct Answer = D..............

The cause of urinary incontinence in most cases is intrinsic sphincteric incompetence, for which the treatment options are anticholinergic therapy, collagen injections, sling procedures, and artificial urinary sphincter implantation.

Severe urinary incontinence is one of the most serious adverse outcomes of radical prostatectomy. The rates of postprostatectomy incontinence requiring treatment range from 3% to 60% in the literature depending on the definition of incontinence and the method for obtaining data.

The cause of urinary incontinence in most cases is intrinsic sphincteric incompetence, for which the treatment options are anticholinergic therapy, collagen injections, sling procedures, and artificial urinary sphincter implantation. Incontinence due to the serotonergic antidepressant agents has been described but is rare.

In addition, because the use of sertraline predated the onset of this patient's symptoms, discontinuing sertraline is unlikely to be an effective intervention. The patient did not respond to tolterodine and is therefore unlikely to respond to oxybutynin.

There is no evidence of efficacy for behavioral therapy in patients with postprostatectomy urinary sphincter incontinence.