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General Reference ⬇

(Urol Clin NA 1998;25:625; Am Fam Phys 1998;57:2675)

Pathophys and Cause ⬆ ⬇

Cause:Estrogen deficiency effect on urethral mucosa; or pelvic relaxation after childbirth or urologic surgery; neuropathies; No Image-blocking meds

Pathophys:Sphincter insufficiency

Signs and Symptoms ⬆ ⬇

Sx:Loss of urine w cough, sneeze, laugh

Si:Cystocele on physical exam if due to pelvic relaxation

Treatment ⬆

Rx:Kegel exercises, 3 sets of 7-sec contractons qid (Jags 1983;31:476); wgt loss of 15-20 lb decr incontinence × 50% (Nejm 2009;360:481); pessaries (Am Fam Phys 2000;61:2723); surgery (suburethral sling or open retropubic culposuspension) (Nejm 2010;362:2066, 2124; 207;356:2143) but postop outlet obstruction and incontinence (Jags 2007;55:1927). Estrogen vaginally no help by DBCT (Jama 2005;293:935)

of neuropathic types, imipramine 25+ mg hs (No Image-stimulation, parasympathetic inhibition); or biofeedback (Ann IM 1985;103:507)/behavioral therapy (Jama 2003;290:345)