08-28-2014, 07:56 PM
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
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