Mixed and Drug Induced UI4

Frequently, two or more types of UI may coexist in a given patient, combinations termed mixed UI. This can lead to diagnostic and therapeutic difficulties due to the confusing array of presenting signs and symptoms and the opposing effects that a given treatment can have in different types of UI (i.e., a given drug may reduce the signs and symptoms of one type of UI but worsen those of other types). Another interesting type of mixed UI is coexisting bladder overactivity (UUI) and impaired bladder contractility (OUI). Most common in the elderly, this combination is called detrusor hyperactivity with impaired contractility (DHIC).

'0' Many medications can influence the lower urinary tract, including those not usedfor managing genitourinary disorders, and can precipitate new onset or aggravate existing voiding dysfunction and UI (Table 53-1).

Table 53-1 Medications Influencing Lower Urinary Tract Function

Medication

Effect

Diuretics a-Adrenoceptor antagonists a-Adrenoceptor agonists

Calcium channel blockers

(dihydropyridines) Opioid analgesics

Sedative-hypnotics

Psychotherapeutics with anticholinergic properties; anticholinergics TCAs

Ethanol

ACE Is

Cyclophosphamide

Polyuria, frequency, urgency

Urethral relaxation: may relieve obstruction in males, induces/worsens SUI in females

Urethral constriction: aqqravates obstruction in males (may cause urinary retention), potential SUI treatment in females

Urethral constriction (may cause urinary retention), especially in males

Impaired bladder contractility (may cause urinary retention)

Functional UI due to immobility, delirium, sedation

Urinary retention due to impaired bladder contractility or potential UUI treatment

Combination of anticholinergic and a-adrenoceptor blocking activities can lead to unpredictable effects on UI

Polyuria and freqjency (via effects on ADH), functional UI (delirium, sedation), urgency

Cough leading tc SUI (ARBs do not induce cough)

Hemorrhagic cysiitis due to acrolein metabolite (prevent with MESNA)

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