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  • Image not available. In evaluating urinary incontinence, drug-induced or drug-aggravated etiologies must be ruled out.
  • Image not available. Accurate diagnosis and classification of urinary incontinence type are critical to the selection of appropriate pharmacotherapy.
  • Image not available. Nonpharmacologic, nonsurgical therapy is the cornerstone of management of several types of urinary incontinence, often should be the first therapy initiated, and should be continued even when drug therapy is initiated.
  • Image not available. Anticholinergic/antispasmodic agents are the pharmacologic therapies of choice for bladder overactivity (urge incontinence).
  • Image not available.Duloxetine (not approved for treatment of urinary incontinence in the United States), α-adrenergic receptor agonists, and topical (vaginal) estrogens (alone or together) are the pharmacologic therapies of choice in urethral underactivity (stress incontinence).
  • Image not available. Patient-specific treatment goals should be identified. They are not static and may change over time. Choice of therapy may be influenced by characteristics such as patient age, comorbidities, concurrent medications, and ability to adhere to the prescribed regimen. If therapeutic goals are not achieved with a given agent at optimal dosage, addition of a second agent or switching to an alternative single agent should be considered.

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

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  • 1. Describe the normal micturition cycle.
  • 2. List the physiologic factors responsible for the maintenance of urinary continence.
  • 3. Explain the pathophysiologic basis for the main types of urinary incontinence.
  • 4. Compare and contrast the clinical presentations of the main types of urinary incontinence.
  • 5. Discuss the risk factors for the main types of urinary incontinence.
  • 6. Identify those drugs that can precipitate new-onset or aggravate existing urinary incontinence.
  • 7. Describe the components of the physical examination of a patient undergoing evaluation for urinary incontinence.
  • 8. Discuss diagnostic tests that can assist in the evaluation of a patient with urinary incontinence.
  • 9. Compare and contrast the nonpharmacologic treatments of the main types of urinary incontinence.
  • 10. Compare and contrast the side-effect profiles of the agents used to treat urge urinary incontinence.
  • 11. List the factors guiding selection of a specific drug for urinary incontinence for an individual patient.
  • 12. Select an appropriate drug for urinary incontinence based on patient-specific data.
  • 13. List the factors affecting adherence for a patient receiving drug therapy for urinary incontinence.
  • 14. Formulate a monitoring plan for a patient on drug therapy for urinary incontinence based on patient-specific information and the prescribed regimen.
  • 15. Formulate appropriate counseling information to be provided to a patient receiving drug therapy for urinary incontinence, given patient-specific information and the prescribed regimen.

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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 a common yet underdetected and underreported health 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 ...

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