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Chapter 53. Urinary Incontinence and Pediatric Enuresis

Student Questions

All of the following are risk factors for stress urinary incontinence except:

A. Childbirth

B. Radical prostatectomy

C. Use of nasal decongestant

D. Menopause

Answer: C

Option A: Incorrect. Childbirth via vaginal delivery is a risk factor for stress urinary incontinence.

Option B: Incorrect. Radical prostatectomy is a risk factor for stress urinary incontinence.

Option C: Correct. Nasal decongestant, such as pseudoephedrine, may be a treatment, not a risk factor, for stress urinary incontinence.

Option D: Incorrect. Menopause is a risk factor for stress urinary incontinence.

A 70-year-old patient is diagnosed with overactive bladder with occasional urge urinary incontinence during daytime (once or twice weekly). Her past medical history includes congestive heart failure, chronic constipation, falls, glaucoma, hypothyroidism, spinal stenosis, and osteoarthritis. She is taking appropriate medications for her health conditions. She prefers an oral treatment that is least likely to cause constipation, dry mouth, or other anticholinergic side effects. You recommend:

A. Desmopressin

B. Mirabegron

C. Oxybutynin IR

D. Oxybutynin TDS

Answer: B

Option A: Incorrect. Desmopressin is indicated for nocturia, but overactive bladder. Also, it is contraindicated in patients with hyponatremia.

Option B: Correct. Mirabegron is a beta-3-adrenergic agonist. It is least likely to cause anticholinergic side effects.

Option C: Incorrect. Oxybutynin IR is an antimuscarinic agent and causes high incidences of constipation and dry mouth.

Option D: Incorrect. Oxybutynin TDS is a topical treatment. It gives lower incidence of dry mouth, but patient prefers an oral treatment.

An appropriate agent for managing urge urinary incontinence in the elderly is:

A. Imipramine

B. Phenylpropanolamine

C. Darifenacin

D. Bethanechol

Answer: C

Option A: Incorrect. Imipramine is a tricyclic antidepressant which is no more effective than oxybutynin IR, but can cause potentially serious adverse effects.

Option B: Incorrect. Phenylpropanolamine has been used to treat stress urinary incontinence. It has been removed from the market due to associated risk of ischemic stroke.

Option C: Correct. Darifenacin is an antimuscarinic agent for urge urinary incontinence.


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