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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Explain the pathophysiology of the major types of urinary incontinence (UI): urge, stress, overflow, and functional.

  2. Recognize the signs and symptoms of the major types of UI in individual patients.

  3. List the treatment goals for a patient with UI.

  4. Compare and contrast available therapeutic agents for managing UI; identify factors that guide drug selection for an individual patient.

  5. Formulate a monitoring plan and provide patient counseling for a patient on a given treatment regimen based on patient-specific information.

  6. Explain the pathophysiology of pediatric enuresis.

  7. List treatment goals; compare and contrast available therapeutic agents for managing pediatric enuresis.

  8. Formulate a patient-specific monitoring plan and implement patient counseling for a patient on a given treatment regimen.

  9. Describe nonpharmacologic treatment approaches for pediatric enuresis.

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URINARY INCONTINENCE

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INTRODUCTION

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Urinary incontinence (UI) is defined as the complaint of involuntary leakage of urine.1 It is often associated with other bothersome lower urinary tract symptoms such as urgency, increased daytime frequency, and nocturia. Despite its prevalence across the lifespan and in both sexes, it remains an underreported health problem that can negatively impact an individual’s quality of life. Patients with UI may sense a loss of self-control, independence and self-esteem, and often modify their activities for fear of an “accident.” Patients with UI may also suffer from other consequences, including perineal dermatitis and infections, pressure ulcers, urinary tract infections (UTIs) and falls. In the United States, the estimated national cost of urge urinary incontinence (UUI) in 2007 was $66 billion, with projected costs of $76 billion in 2015 and $83 billion in 2020.2

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EPIDEMIOLOGY AND ETIOLOGY

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The true prevalence of UI is unclear because of varying definitions of UI and reporting bias.3

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  • About 44% of noninstitutionalized persons aged 65 and older reported UI4

  • 7% to 37% of women aged 20 to 39 report some degree of UI

  • 9% to 39% of women age 60 and over report daily UI

  • 11 to 34% among older men report some degree of UI

  • 2 to 11% of older men reporting daily UI

  • In the noninstitutionalized setting, more than 50% of elderly women and more than 25% of elderly men reported UI

  • 46% of short-term and 76% of long-term nursing home residents report UI4

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UI can result from abnormalities within (intrinsic to) and outside of (extrinsic to) the urinary tract. Within the urinary tract, abnormalities may occur in the urethra (including the bladder outlet and urinary sphincters), the bladder, or a combination of both structures. Focusing on abnormalities in these two structures, a simple classification scheme emerges for all but the rarest intrinsic causes of UI. KEY CONCEPT Accurate diagnosis and classification of UI type is critical to the selection of appropriate drug therapy.

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PATHOPHYSIOLOGY

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