Overflow Incontinence Due to Bladder Underactivity4

In overflow UI due to atonic bladder, a trial of bethanecol may be reasonable if contraindications do not exist. There is no established effective pharmacologic therapy for OUI due to poor bladder contractility (atonic bladder). The efficacy of the cholinomimetic bethanecol (25-50 mg three or four times daily) is uncertain and, in well done clinical trials, it has had mixed results. In addition, its cholinomimetic effect is not urospecific and its side effects are bothersome, including muscle and abdominal cramping, hypersalivation, diarrhea, and potentially life-threatening bradycardia and bronchospasm. a-adrenoceptor antagonists such as silodosin, prazosin, terazos-in, doxazosin, tamsulosin, and alfuzosin may benefit this condition by relaxing the bladder outflow tract and hence reducing outflow resistance. If pharmacologic therapy fails, intermittent urethral catheterization by the patient or caregiver three or four times per day is recommended. Less satisfactory alternatives include indwelling ur-ethral or suprapubic catheters or urinary diversion.

Table 53-4 Drugs Used for SUI

Pirirtltlir

Eilmsens

Pifudfri-phedrlnr

Dulost'l In ll

Dosage forms

Oosing

Kireliiï

pteis^nüsrii

Avoid systemic (paremeral.orat,

1D>, -.ItC ViKjilldl" [jbM.UlNfl, CWJvJ^HvJl rirH|

Estradiol ïi meg vaginal t.inlei t (inierl ooe FVdaity r dttyv (tien une PV (wife wWllyt CEE vaginal cieam (1/>->h daily P^ isyt i witii J WPtKi cfir 1 vrtxk cff; may be able to ikrraie frequency of use tuer lime) EMradiOl 2 rill | v.k;.'vil rirxp 11 liiiii Pv every Î monlhs)

Use VxjI loule inin<mue lïîKm": BA dr>d iklteffcCTl

Gonnindluflanfhdud« üncnwn o< inspected toejst oi endometrial career Abnormal t)irtili>uiiii5ry(ili.>t0iin|

of unknown etiology Active lh<ombuembollsm (t> hüKKyOf TE üiiXti»d with previous estrogen uv)

lableti. sol un on

15-60 mg I x daily l.pss than Hh oidose k rneuboSi«] inactive melabohes) Prirnaiily rerul limitation of unchanged ditm

Wr<i,ld not enrect hepatic Impriment to i«ve an efliett (tk: d.n.s Ejpcct significant e<l«tl1 renal irn|M-rni'iir ric> iftïi [ if advanced aqe (beyond decreased Cit I with age)

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