When Your Patients Gotta Go!!!!!

Raji Gill, D.O., M.Sc.Clinical Assistant Professor of Surgery

Division of UrologyOklahoma State University

Incontinence

• Types• Overflow / retention• Stress / overactive

History

• Urgency, frequency, nocturia• Incomplete bladder emptying• Leak when straining• Weak stream, post void dribbling

Past Medical Conditions

• Multiple sclerosis, spinal cord injury

• Diabetes• Parkinsons Disease

Medications

• Worsen overflow • Ephedrine (Rynatuss),

pseudoephidrine, imiprimine (Tofranil)Worsen stress• Clonidine (Catapress),

phenoxybenzamine

Physical

• Check post void residual (PVR)• Normal less than 50cc• Abnormal more than 200cc

• Digital rectal exam• Larger prostate (more than • 40 gms)

Treatment

• Overflow / retention• If PVR 50 – 200cc, timed voids, double

voids• If PVR > 200cc, straight cath or foley

• Stress / overactive• Do not hold urine

Medical Therapy• Overflow

• Alpha blockers act on smooth muscle receptors in the prostate (Hytrin, Cardura, Flomax)

• 5 alpha reductase inhibitor lowers dihydrotestosterone levels (Proscar, Avodart)

• Stress / overactive• Anticholinergics for involuntary detrusor

contraction (Ditropan, Detrol)• Tricyclic anidepressants (Imipramine,

Tofranil)

Surgical Therapy

• TURP, microwave therapy, thermotherapy for enlarged prostates

• Periurethral injections• Urethral suspensions• Sphincter prosthesis• Sacral nerve stimulation

The End