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Old 12-21-2016
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Thumbs Down Q regarding urinary incontinence...NBME 6

57yo M with intermittent urainry incontinence over the past 6 months. Loss of small amounts of urine when he coughs or sneezes. No pain or blood with urination. 15-year hx of T2DM with peripheral neuropathy, retinopathy, and gastroparesis. Nroaml-sized prostate. Neuro exam shows decreased sensation in a stocking-glove distribution. Achilles tendon reflexes absent bilaterally. U/A shows 2+ protein with no leukocytes or erythrocytes. Postvoid residual volume is 500mL. Mechanism of incontinence?

Answer:
- Overflow incontinence from acontractile bladder

I THOUGHT SINCE HE LEAKS URINE WHILE COUGHING AND SNEEXING IT WOULD BE STRESS INCONTINENCE LIKE FACTOR

Would appreciate any insight!

Thanks
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Old 01-15-2017
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Default

Quote:
Originally Posted by Virgo11 View Post
57yo M with intermittent urainry incontinence over the past 6 months. Loss of small amounts of urine when he coughs or sneezes. No pain or blood with urination. 15-year hx of T2DM with peripheral neuropathy, retinopathy, and gastroparesis. Nroaml-sized prostate. Neuro exam shows decreased sensation in a stocking-glove distribution. Achilles tendon reflexes absent bilaterally. U/A shows 2+ protein with no leukocytes or erythrocytes. Postvoid residual volume is 500mL. Mechanism of incontinence?

Answer:
- Overflow incontinence from acontractile bladder

I THOUGHT SINCE HE LEAKS URINE WHILE COUGHING AND SNEEXING IT WOULD BE STRESS INCONTINENCE LIKE FACTOR

Would appreciate any insight!

Thanks
Normal postvoidal vol. for male is 50 ml.In case of stress incontinence the post voidal volume has to be normal .
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Old 01-21-2017
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Default Overflow incontinence

So the fact that the urine leaks when he coughs or sneezes was inserted there as a distraction but the reason this happens in this case is because those things results in ↑ intraabdominal pressure which exceeds the sphincteric pressure and allows for leakage of urine from a 'full' bladder but in normal people, the drive to urinate is transmitted to the bladder and sphincter by nerves which has been lost in this man due to his long hx of DM.
Hence, as @sari noted, this residual vol of urine is expected in overflow incontinence as it shows there's an accumulation of urine and distended bladder.
Finally, as a side note, stress incontinence almost always occurs exclusively in women.
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