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KEY CONCEPTS

KEY CONCEPTS

  • image In evaluating urinary incontinence (UI), drug-induced or drug-aggravated etiologies must be ruled out.

  • image Accurate diagnosis and classification of UI type are critical to the selection of appropriate pharmacotherapy.

  • image Goals of treatment for UI are reduction of symptoms, minimization of adverse effects, and improvement in quality of life.

  • image Nonpharmacologic, nonsurgical treatment is the first-line treatment for several types of UI, and should be continued even when drug therapy is initiated.

  • image Antimuscarinic agents are second-line treatments for urgency incontinence. Choice of agent should be based on patient characteristics (eg, age, comorbidities, concurrent medications, and ability to adhere to the prescribed regimen).

  • image Mirabegron, a β3-adrenergic agonist, is another second-line treatment for urgency incontinence, and can be considered in patients who failed to achieve optimal efficacy or cannot tolerate adverse effects of antimuscarinic agents.

  • image Duloxetine (approved in Europe only), α-adrenergic receptor agonists, and topical (vaginal) estrogens (alone or together) are the drugs of choice for urethral underactivity (stress incontinence).

  • image Assessment of patient outcomes should include efficacy, adverse effects, adherence, and quality of life.

  • image Management of UI should target individualized goals and treatment preferences, which may change over time. If therapeutic goals are not achieved with a given agent at optimal dosage for an adequate duration of trial, consider switching to an alternative agent.

PRECLASS ACTIVITY

Preclass Engaged Learning Activity

Read or listen to the topic summary on urinary incontinence from Quick Pharmacy Answers in Access Pharmacy by Lauren Roller. The summary is based on the 10th edition of this textbook chapter. This exercise allows the learners to gain a concise overview of the topic.

INTRODUCTION

Urinary incontinence (UI) is defined as involuntary leakage of urine.1 It is frequently accompanied by other bothersome lower urinary tract symptoms, such as urgency, increased daytime frequency, and nocturia. It is one of the most common health conditions occurring in adults, and yet it is an underdetected and under-reported problem that can significantly affect quality of life. Patients with UI may have depression as a result of the perceived lack of self-control, loss of independence, and lack of self-esteem, and they often curtail their activities for fear of an “accident.” UI may also have serious medical and economic ramifications for untreated or undertreated patients, including perineal dermatitis, worsening of pressure ulcers, urinary tract infections, and falls.

This chapter highlights the epidemiology, etiology, pathophysiology, treatment of stress, urgency, mixed, and overflow UI in men and women.

EPIDEMIOLOGY

UI is highly prevalent, and the impact of this condition is substantial, crossing all racial, ethnic, and geographic boundaries. In addition, lower urinary tract symptoms (eg, urgency, urinary frequency, and nocturia) associated with overactive bladder (OAB) are also quite debilitating.2 Evidence from several studies indicates that UI is associated with reduced levels of social and personal activities, increased psychological distress, and overall decreased quality ...

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