Stress urinary incontinence

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a. SUI due to sphincter insufficiency is treated with alpha-adrenergic agonists. Phenylpropanolamine or pseudoephedrine is the first line of pharmacologic therapy for women with SUI. Side effects include anxiety, insomnia, agitation, respiratory difficulty, headache, sweating, hypertension, and cardiac arrhythmia. Use caution with arrhythmias, angina, hypertension, or hyperthyroidism.

b. Estrogen replacement restores urethral tone, and alpha-adrenergic response of urethral muscles. Combined therapy (estrogen and alpha-adrenergic agonists) may be more effective than alpha-adrenergic agonist therapy alone.

c. Imipramine may be used in patients who do not respond to the above treatment. It has alpha-adrenergic agonist and antic holinergic activities and is reported to benefit women with SUI. Side effects include nausea, postural hypotension, insomnia, weakness, and fatigue.

3. Overflow incontinence. If overflow incontinence is caused by an anatomic obstruction, and the patient is an acceptable surgical candidate and has an adequately functioning detrusor muscle, then surgery to relieve the obstruction is the treatment of choice. In women, anatomic obstruction can result from severe pelvic prolapse or previous surgery for incontinence. Intermittent catheterization is the treatment of choice in patients with detrusor muscle underactivity, with or without obstruction.

References: See page 146.

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