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Treatment of complex cases 

Treatment of complex cases
Chapter:
Treatment of complex cases
Author(s):

W. Stuart Reynolds

and Roger R. Dmochowski

DOI:
10.1093/med/9780199599394.003.0006
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date: 23 May 2019

In patients with mixed urinary incontinence, prioritising the most bothersome component (stress or urgency urinary incontinence) will help to direct initial primary therapy.

Urinary sphincter damage during prostatectomy is the primary cause of incontinence in men after prostatectomy and can be treated effectively with an artificial urinary sphincter or male sling procedure.

Concomitant urinary incontinence and pelvic organ prolapse is common in women; occult or undiagnosed stress urinary incontinence can often be demonstrated in women with significant prolapse and no subjective complaints of incontinence, either on pre-operative prolapse reduction testing or after prolapse treatment.

Treatment for neurogenic overactive bladder syndrome should be directed by findings on pretreatment testing (e.g. urodynamics) and often requires modification and re-assessment over time as the neurologic process evolves and long-term bladder changes develop.

A multidisciplinary perspective on urinary incontinence in elderly patients can help identify many potential contributory factors that are not directly related to the genitourinary system, but may have significant impacts on continence care.

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