Urology & Gynecology & Physiotherapy & Family Medicine
Urinary incontinence
Urinary incontinence (UI) is defined by the International Continence Society (ICS) as any involuntary loss of urine that constitutes a social or hygienic problem. It affects around 200 million people worldwide, and is one of the most under-reported conditions - shame and embarrassment mean that the majority of patients do not consult a healthcare professional until 6 to 9 years after the onset of symptoms. In Canada, prevalence is estimated at 10-25 % in adult women (all forms) and 3-10 % in men, with a marked increase after the age of 65. Urinary incontinence has a profound impact on quality of life: social and professional limitations, increased risk of urinary infections, nocturnal falls (in the elderly), depression and social isolation. There are three main forms of urinary incontinence: stress urinary incontinence (SUI - leakage when abdominal pressure is increased: coughing, sneezing, sport) due to a deficiency in the urethral closure mechanism, urge urinary incontinence (UUI - leakage associated with a sudden and urgent need to urinate) due to detrusor overactivity, and mixed urinary incontinence (MUI - a combination of the two forms). Management is graded: behavioral measures and perineal rehabilitation in the first line (level A recommendation for all forms), pharmacotherapy in the second line (anticholinergics + beta-3-agonists for UUI; duloxetine for SUI), and surgery in the third line (suburethral sling - TVT/TOT - for refractory SUI; botulinum toxin A injections + SACM for refractory UUI).
Classification, pathophysiology, and clinical evaluation
- Pathophysiology of continence and mechanisms of incontinence: normal continence mechanism: internal urethral sphincter (bladder neck - smooth) → sympathetic tone (α1-receptors) → closure → external urethral sphincter (striated - perineum) → voluntary control + basal tone → pelvic floor (anus elevator muscles + pubococcygeal muscles) → vesic-urethral junction support + strengthened during exertion + innervation: internal sphincter → sympathetic system (T10-L2) + pudendal (S2-S4) → external sphincter → pudendal nerve (S2-S4) → detrusor → parasympathetic (S2-S4) + inhibited by sympathetic during filling → normal micturition: filling → central detrusor inhibition + sphincter contraction → when micturition is decided → sphincter relaxation + coordinated detrusor contraction → complete emptying; mechanisms of SUI: failure of urethral support mechanism (urethral hypermobility - descent of vesicourethral junction during exertion → low urethral pressure → leakage during abdominal pressure peaks) + and/or intrinsic sphincter deficiency (ISD - Intrinsic Sphincter Deficiency - low urethral closing pressure) → factors: multiple pregnancies + vaginal deliveries → trauma to pelvic structures + pudendal nerve → menopause → urogenital atrophy + reduced collagen and muscle support → obesity → chronic increase in abdominal pressure → previous pelvic surgery → DeLancey 1994 - American Journal of Obstetrics and Gynecology : hammock theory - urethral support depends on an interaction between anterior vaginal wall + endopelvic fasciae + anus elevator muscles + mechanisms of IUU (detrusor hyperactivity): uninhibited detrusor contractions during the filling phase → inappropriate activation of the parasympathetic pathway (ACh → M2/M3 receptors → contraction) + reduction of inhibitory pathways (supra-pontine + pontine pathways) + increased sensitivity of afferent pathways (C-fibers - substance P + TRPV1) → causes: idiopathic (85 %) + neurological (MS + Parkinson + stroke + spinal cord injury) + subvesical obstruction → cystitis + bladder stone → detrusor hyperactivity detected by urodynamics: unstable contractions >5 cmH₂O → OAB (Overactive Bladder) if functional symptoms without urodynamic evidence → mechanisms of SUI by overflow : chronic urinary retention → bladder distension → overflow → in men (prostatic obstruction) + in women (cystocele + severe prolapse + detrusor hypocontractility) → important differential diasnostic as treatment is opposite (neither anticholinergics nor anti-incontinence surgery)
- Clinical evaluation and assessment of urinary incontinence: Structured interview — key elements: type of incontinence: pure stress (cough + sneeze + sport + laughter) → SUI + urgency + desire + leakage before reaching the toilet → UUI + combination of both → MUI → quantification: number of episodes/day + number of pads used → validated questionnaire: International Consultation on Incontinence Questionnaire — Short Form (ICIQ-SF) → score 0–21 → severity + impact on quality of life + voiding diary: essential tool → patient records for 3 days: time of each void + voided volumes + urges + leakages + fluid intake → evaluates: voiding frequency (normal <8 mictions24h) + nycturie (normale <1nuit) volume mictionnel normal (250–400 ml miction)polydipsie ou polyurie → symptômes associés : dysurie infection urinaire à exclure flux faible globe vésical rétention hématurie cystite lithiase tumeur vésicale antécédents obstétricaux gynécologiques chirurgie pelvienne médicaments (diurétiques α-bloquants anticholinergiques psychotropes) comorbidités (dt2 bpco constipation obésité) examen physique neurologique rapide (réflexe anal bulbocaverneux sensibilité périnéale) gynécologique prolapsus (classification pop-q) atrophie vaginale tonus sphinctérien au toucher rectal test la toux remplir vessie faire tousser en position debout fuite synchrone ="IUE" résidu post-mictionnel (rpm) écho-vésicale <50–100 rpm>300 mL → retention → IU by overflow → urinalysis: UTI screening → urine culture and sensitivity if UA positive → urodynamics (urodynamic study - UDS): indicated if: before anti-incontinence surgery + refractory UI + diagnostic doubt + high post-void residual (PVR) + male incontinence + failure of well-managed treatment → measures: cystometry + uroflowmetry + urethral pressure profilometry + perineal EMG → Abrams 2002 — Urology: ICS definitions and recommendations for urodynamic studies → diagnostic gold standard + pelvic ultrasound or cystoscopy: according to clinical indications (hematuria + prolapse + suspected fistula)
Urinary incontinence treatment
| Treatment / shape | Data, methods and results | Key studies and recommendations |
|---|---|---|
| Behavioral measures and pelvic floor rehabilitation — 1st line for all forms Kegel exercises — perineal rehabilitation — biofeedback — bladder training — caffeine reduction — weight loss — pelvic physiotherapist |
Behavioural measures - 1st line recommended before any pharmacological or surgical treatment: reduction of caffeine and alcohol: caffeine is a bladder irritant + diuretic → reduction to <200 mg/d (2 cups of coffee) → Minassian 2013 - BJOG: reduction of caffeine → improvement of urgency and nocturia + optimized water intakes: neither too little (2 L/d) → aim for 1.5 L/d spread throughout the day + reduce or eliminate intakes in the evening if nocturia + weight loss: BMI ≥30 → increase × 2-4 in SUI risk → Subak 2009 - NEJM (PRIDE trial, RCT n=338 obese women): weight loss of 8 % → 47 % reduction in SUI and UUI episodes vs 28 % control group → weight loss = major therapeutic intervention in SUI + constipation: actively treat chronic constipation (fiber + hydration + laxatives) → defecation efforts → increase abdominal pressure → SUI + UUI + treatment of chronic cough (COPD + drugs - IEC) → reduction of SUI episodes + topical vaginal estrogens (in postmenopausal women): urogenital atrophy → fragility of vesicourethral mucosa + reduced sphincter tone → vaginal estrogens (Premarin cream + Vagifem ovule + Estring ring) → restore urothelial epithelium → reduced bladder irritation → Cody 2012 - Cochrane: local estrogens → improvement of UUI and SUI in postmenopausal women → no systemic estrogens for SUI (no efficacy + cardiovascular risk); perineal re-education - mainstay of SUI and UUI treatment: pelvic floor exercises (Kegel): sustained contraction of pelvic floor muscles × 3 sets of 10 contractions/d (10 seconds contraction + 10 seconds release) → pelvic floor strengthening → improves urethral support + pre-micturition contraction reflex → program supervised by a physiotherapist specialized in pelvic health = results superior to self-training → Hay-Smith 2011 - Cochrane: supervised pelvic floor exercises (PPE) vs. no treatment → SUI: 56-70 % reduction in episodes + IUU: 30-45 % reduction → level A recommendation → duration: minimum 3 months before assessment of efficacy → perineal biofeedback: use of an intra-vaginal or intra-rectal pressure sensor → helps patient visualize pelvic floor contractions → improves exercise efficacy + coordination + stress leakage + intra-vaginal or transcutaneous electrostimulation (TENS): electrical stimulation of S2-S4 roots → reflex inhibition of detrusor + muscle strengthening → useful in IUU + SUI due to sphincter deficiency → bladder training - for IUU : gradually lengthen inter-void intervals → emergency resistance → increase functional bladder capacity + emergency diversion techniques (rapid pelvic floor contractions during an emergency → detrusor inhibition reflex) → Wyman 1998 - Obstetrics and Gynecology: bladder training → 57 % reduction in UUI episodes → comparable to oxybutynin with fewer side effects + overall results of re-education: SUI: cure or significant improvement in 60-70 % of women after 3-6 months + UUI: cure or improvement in 40-60 % → durability: results maintained at 1-2 years if practice is maintained → in post-prostatectomy men: PPE started early → return to continence significantly faster (Centemero 2010 - European Urology) | Subak 2009 — NEJM (PRIDE trial RCT n=338): weight loss 8 % → −47 % episodes of SUI/UUI → weight loss = Level A treatment + Hay-Smith 2011 — Cochrane: supervised PEs → −56–70 % SUI + −30–45 % UUI → Level A first-line + Wyman 1998 — Obstetrics and Gynecology: bladder training → −57 % episodes UUI → Cody 2012 — Cochrane: local estrogen → improvement UUI + SUI in menopausal women + Centemero 2010 — European Urology: early PEs post-prostatectomy → faster return of continence + Minassian 2013 — BJOG: caffeine reduction → improvement urgency + nocturia + American Urological Association (AUA) 2019 + Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) 2019: pelvic floor muscle training = first-line treatment all forms + NICE 2019 NG123: PEs 3 months minimum before pharmacological treatment + SOGC 2018: female urinary incontinence → rehabilitation = first-line |
| Pharmacotherapy - IUU and IUE Anticholinergics — oxybutynin — tolterodine — solifenacin — mirabegron — beta-3 agonist — duloxetine — adverse effects — elderly subjects — contraindications |
Pharmacotherapy of IUU - detrusor hyperactivity: anticholinergics (antimuscariinics) - mechanism: blockade of detrusor M2 + M3 muscarinic receptors → reduction of uninhibited contractions → frequency reduction + urgency + leakage → drugs available in Canada: oxybutynin (Ditropan) 5 mg × 2-3/d or LP 5-10 mg/d → most studied agent + less expensive + but: most important anticholinergic effects (xerostomia + constipation + cognitive impairment) → transdermal oxybutynin (patch or gel): fewer systemic effects → tolterodine (Detrol) 2 mg × 2/d or LP 4 mg/d → better tolerance profile than oxybutynin → solifenacin (Vesicare) 5-10 mg/d → trospium chloride (Trosec) 20 mg × 2/d → fesoterodine (Toviaz) 4-8 mg/d → darifenacin (Enablex) 7.5-15 mg/d → efficacy of anticholinergics : Chapple 2005 - European Urology (meta-analysis): anticholinergics vs placebo → reduction in urgency by 35-40 % + reduction in leakage by 40-50 % + reduction in voiding frequency → high drop-out rate (30-40 %) due to adverse effects + common adverse effects: xerostomia + constipation + blurred vision + tachycardia + cognitive impairment (BBB passage) → particularly problematic in the elderly → CONTRAINDICATED if: angle-closure glaucoma + urinary retention (RPM >200 mL) + Alzheimer's disease + gastric stasis → Beers Criteria 2019: oxybutynin + anticholinergics → not recommended in the elderly → risk of cognitive impairment + confusion + falls → prefer mirabegron; beta-3-agonist (mirabegron - Myrbetriq) - alternative to anticholinergics: mechanism: β3-adrenergic receptor agonist in bladder wall → detrusor relaxation during filling → increased bladder capacity + reduced uninhibited contractions → Chapple 2013 - European Urology: mirabegron vs oxybutynin vs placebo → mirabegron non-inferior to oxybutynin + modest cardiovascular effects (slight increase in HR + BP) → no anticholinergic effects + superior tolerance profile → dosage: 25-50 mg/d → good tolerance in elderly subjects (no cognitive effect) → BUT: cardiovascular effects → use cautiously if uncontrolled hypertension + contraindicated if: severe hepatic/renal insufficiency + uncontrolled hypertension → Nitti 2013 - Journal of Urology: mirabegron × 12 weeks → reduction in urgent leaks + frequency → good tolerance + mirabegron + anticholinergic (solifenacin) in combination: positive data (SYNERGY study) → superior reduction vs monotherapy + combination approval (Vibegron - Gemtesa - new beta-3 agonist available in Canada + USA 2020) → Bladder Botox (botulinum toxin A - Onabotulinumtoxin A): intravesical injection × 20 sites → 100 IU (neurogenic OAB: 200 IU) → inhibition of ACh release from presynaptic terminals → partial detrusor paralysis → indicated if IUU refractory to ≥2 drugs → efficacy: 60-70 % leakage reduction → Nitti 2017 - Journal of Urology: Botox vesical 100 IU → 27 % of complete continence + post-injection urinary retention rate: 5-6 % (temporary catheterization required) → duration of effect: 9-12 months → reinjection if recurrence; SUI pharmacotherapy: duloxetine (Cymbalta - IRSNA antidepressant): sphincter tone enhancement (strengthening of external urethral sphincter tone via Onuf nucleus serotonergic + noradrenergic pathways) → dosage: 20-40 mg × 2/d → reduction of SUI episodes by 50-60 % → no MA in Canada for SUI specifically (off-label use) → adverse effects: nausea (30 % → reduce after 4 weeks) + dry mouth + sleep disorders + suicidal risk (warning label) → Norton 2002 - BJOG (meta-analysis): duloxetine → reduction in SUI episodes + quality of life → modest efficacy vs surgery + alpha-agonists (ephedrine + pseudoephedrine): old treatments → withdrawn or little used (cardiovascular effects) + vaginal estrogens: improvement in mild SUI (see rehabilitation section) | Chapple 2005 - European Urology (meta-analysis): anticholinergics vs placebo → reduction urgency 35-40 % + leakage 40-50 % + but high dropout rate + Chapple 2013 - European Urology: mirabegron vs oxybutynin → non-inferior + fewer adverse effects → recommended in the elderly + Nitti 2013 - Journal of Urology: mirabegron → leakage reduction + frequency + good tolerance + Nitti 2017 - Journal of Urology: Botox vesical 100 IU → 27 % complete continence + retention rate 5-6 % + Norton 2002 - BJOG: duloxetine → reduced SUI episodes + modest vs surgery + Beers Criteria 2019 (AGS): oxybutynin + elderly subjects → not recommended (cognitive impairment) → mirabegron + transdermal oxybutynin preferred + AUA/SUFU 2019: 2nd-line pharmacotherapy after rehabilitation + anticholinergics OR mirabegron → level A + NICE 2019 NG123: pharmacological treatment OAB → anticholinergics or mirabegron if EPP insufficient + Botox if 2 drugs insufficient + SOGC 2018: female UI → anticholinergics + mirabegron = 2nd line |
| Surgery for stress urinary incontinence and treatment of refractory SUI TVT — TOT — Suburethral sling — Colpopexy — Artificial urinary sphincter — Sacral neuromodulation — Intravesical Botox — Posterior tibial nerve stimulation — Outcomes — Complications |
Surgery for SUI in women - indications: failure of perineal rehabilitation ≥3 months + clinically objectified SUI + normal RPM + urodynamics recommended before surgery (if in doubt about the type of incontinence or if associated prolapse); midurethral slings (MUS) - reference surgical treatment for SUI: two approaches: TVT (Tension-free Vaginal Tape - retropubic passage) + TOT (Trans-Obturator Tape - trans-obturator passage) → principle: polypropylene strip positioned under the urethral meatus → dynamic urethral support during efforts → no tension in basal state → Ulmsten 1996 - International Urogynecology Journal: founding publication of TVT → surgical revolution → Ward 2004 - BMJ (RCT TVT vs Burch's colposuspension): TVT = Burch at 2 years (efficacy 85-90 % vs 80-86 %) + TVT: less morbidity + vaginal route + Latthe 2010 - Cochrane: TOT vs TVT → similar efficacy (80-85 %) + TOT: fewer bladder perforations + less retropubic pain → TVT: less inguinal pain → sling complications: de novo emergencies (5-20 %) + dysuria + retention (2-5 %) → temporary catheterization → vaginal or urethral erosion (1-3 % → surgical revision) → chronic pain (inguinal or pelvic - more frequent with TOT) + long-term results: continence at 10 years: 60-70 % depending on series → gradual decrease in efficacy over time → Nilsson 2013 - International Urogynecology Journal: TVT at 17 years → continence 70 % → durability confirmed + Burch colposuspension (laparoscopic or open route): suspension of bladder neck + anterior vaginal wall at pectineal ligaments (Cooper) → similar efficacy to strips → laparoscopic route → Lapitan 2012 - Cochrane: laparoscopic Burch vs TVT → comparable results → more invasive → prefer strips today + Urinary Artificial Sphincter (UAS - AMS 800): severe SUI + intrinsic sphincter deficiency (closing urethral pressure <20 cmH₂O) + post radical prostatectomy + male → inflatable sleeve + scrotal pump + reservoir + results in men: continence at 5 years: 60-80 % → Gousse 2001 - Journal of Urology: UAS in post-prostatectomy SUI → long-term results + male suburethral sling (Advance XP + Virtue): mild to moderate post-prostatectomy SUI → less invasive alternative to UAS; surgical treatment of refractory UUI: sacral neuromodulation (Interstim - SNM): stimulation of sacral nerve S3 → modulation of bladder + sphincter control → temporary electrode test phase (2 weeks) → if response ≥50 % → implantation of definitive generator → Siegel 2000 - Journal of Urology + Sacral Neuromodulation for Urgency Incontinence (SNM) → efficacy: 40-70 % of complete continence → Brazzelli 2006 - Cochrane: SNM → efficacy for refractory IUU → reimbursed in cases of severe refractory IUU + Percutaneous posterior tibial stimulation (PTNS - Percutaneous Tibial Nerve Stimulation): stimulation of the tibial nerve (L4-S3 roots) → reflex inhibition of the detrusor → 12 weekly sessions then maintenance → Peters 2010 - Journal of Urology (PLUS RCT): PTNS vs oxibutynin → comparable efficacy + fewer side effects → non-invasive → good tolerance → injectable periurethral (filling agents): dextranomer/hyaluronic acid (Deflux) + calcium hydroxyapatite (Coaptite) + macroplastic → mild to moderate SUI + sphincter impairment → periurethral injection under cystoscopy → moderate long-term efficacy (40-50 % at 12 months) → reserved for patients not candidates for surgery | Ulmsten 1996 — International Urogynecology Journal: TVT → founding publication + surgical revolution + Ward 2004 — BMJ (RCT TVT vs Burch): TVT = Burch at 2 years + less morbidity → TVT = gold standard + Latthe 2010 — Cochrane: TOT vs TVT → similar efficacy + different complication profile + Nilsson 2013 — International Urogynecology Journal: TVT at 17 years → 70% % continence → durability confirmed + Siegel 2000 — Journal of Urology: SNM + refractory SUI → efficacy + Peters 2010 — Journal of Urology (PLUS RCT): PTNS vs oxybutynine → comparable efficacy + fewer adverse effects + Lapitan 2012 — Cochrane: laparoscopic Burch vs TVT → comparable + AUA/SUFU 2019: slings = first-line surgery for refractory SUI + SNM + Botox for refractory OAB → level A recommendations + NICE 2019 NG123: TVT/TOT recommended + SNM if Botox insufficient + SOGC 2018: SUI surgery + sling complications |
| Special Situations — Male IU, Elderly Subject IU, Neurological IU, and Pregnancy Post-prostatectomy — BPH — elderly subject — frailty — neurological incontinence — MS — Parkinson's — pregnancy — postpartum — vesicovaginal fistula — transient UTI |
UI in men: post radical prostatectomy UI: most frequent cause of male SUI → mechanism: post-surgical sphincter deficiency → severe SUI on resumption of walking → preoperative + immediate postoperative perineal re-education → return of continence in the majority in 3-12 months → Centemero 2010 - European Urology: early PPE → faster continence return → if persistence >12 months → UAS or male strip + IUU by imperiousness + BPH (benign prostatic hyperplasia): subvesical obstruction + secondary bladder instability → treatment: alpha-blockers (tamsulosin 0.4 mg/d) → partial removal of obstruction + 5-ARI (dutasteride + finasteride) if prostate >40 mL → anticholinergics or mirabegron if UI persists after removal of obstruction → RPM monitoring; UI in the elderly - special features: UI is often multifactorial in the elderly → DIAPPERS model (Resnick 1984 - NEJM): reversible causes of transient UI: Delirium + Urinary tract infection + Vaginal atrophy + Pharmacological (diuretics + psychotropic drugs + alcohol) + Psychiatric (depression) + Excess urine output (hyperglycemia + decompensated heart failure) + Restricted mobility + Stool impaction → treat reversible causes as a priority + frailty + cognitive impairment → caregiver education + absorbent protection + accessible toilets + voiding program → medications in the elderly subject: anticholinergics → AVOID (Beers Criteria 2019 → cognitive disorders + confusion + falls) → mirabegron 25 mg/d + transdermal oxybutynin → less anticholinergic alternatives → perineal re-education possible even in the elderly → positive results (Burgio 1998 - Annals of Internal Medicine); Neurological UI: MS (multiple sclerosis): detrusor hyperactivity + detrusor-sphincter dyssynergia → urodynamics essential + treatment: Botox vesical + mirabegron + anticholinergics + intermittent catheterization if high RPM + Parkinson + Alzheimer's disease: imperiousness + detrusor hyperactivity + dopaminergic drugs → possible worsening of UI → mirabegron preferred (no central effects) + spinal cord injury: neurogenic UI → depending on level of lesion → clean intermittent catheterization (SIP) routinely → bladder Botox ++ + neuromodulation + UI during pregnancy and postpartum: pregnancy UI → transient → EPP as early as 1st trimester → systematic postpartum rehabilitation → Mørkved 2003 - BMJ (RCT): EPP started as early as 1st trimester → significant reduction in SUI at 36 SA + at 3 months postpartum → grade III-IV perineal tears → early perineal re-education → vesico-vaginal fistula (VVF): continuous urine loss + declive position → cause: obstetric (obstructive prolonged labor - vesico-vaginal or urethro-vaginal fistula) + or iatrogenic (pelvic surgery) → diagnosis: methylene blue test + cystoscopy + MRI → surgical treatment (vaginal or abdominal closure) | Centemero 2010 — European Urology: Early pelvic floor muscle training (PFMT) + post-prostatectomy → faster return of continence → Resnick 1984 — NEJM: DIAPPERS model → reversible causes of transient urinary incontinence (UI) → seminal review + Burgio 1998 — Annals of Internal Medicine: Pelvic floor muscle training in older adults → as effective as in younger adults → Mørkved 2003 — BMJ (RCT): PFMT during pregnancy → significant reduction in stress urinary incontinence (SUI) at 36 weeks gestation and 3 months postpartum + Beers Criteria 2019: Anticholinergics → not recommended in older adults → mirabegron preferred + AUA/SUFU 2019 + NICE 2019 NG123: Male UI + neurogenic UI + UI in pregnancy → specific recommendations + SOGC 2018: Female UI + pregnancy + postpartum → PFMT recommended from the 1st trimester + ICS 2002 (Abrams): Standardized definitions of UI → international reference + ICIQuest 2023 (International Consultation on Incontinence): Summary of recommendations + levels of evidence for all forms of UI |
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Pelvic floor rehabilitation supervised by a specialized physiotherapist is the first-line treatment for all forms of urinary incontinence — before medication and before surgery: Supervised pelvic floor exercises (Kegels) reduce episodes of OAB incontinence by 56–70% %and those of urgency by 30–45% %. Three to six months of regular training are needed to assess efficacy. In older patients, anticholinergics (oxybutynin) are to be avoided due to the risk of confusion and falls—mirabegron (Myrbetriq) is the recommended alternative.
Situations requiring urgent medical attention
Continuous urinary incontinence + dependent position + history of difficult childbirth or recent pelvic surgery → probable vesicovaginal fistula → urgent urological consultation → methylene blue test + cystoscopy + pelvic MRI → urgent closure surgery (better results with early intervention).
Sudden onset urinary incontinence (de novo UI) + urinary retention + lumbar or abdominal pain + neurological deficit in the lower limbs (weakness + numbness + gait disturbance) → Cauda equina syndrome or spinal cord injury → Medical or neurosurgical emergencies → Urgent spinal MRI → Prompt surgical decompression if compressive lesion.
Severe urinary emergencies + gross hematuria + bladder pain + fever in a patient with no known UTI → Hemorrhagic cystitis or irritating bladder tumor to rule out → Urinalysis + cystoscopy + bladder ultrasound → Do not treat UTI in a patient with hematuria without first ruling out a bladder tumor.
Post-void residual (PVR) >500 mL discovered on bladder ultrasound in a patient complaining of constant urinary leakage + weak urinary flow + enlarged prostate → chronic retention with overflow → urgent urological consultation → indwelling bladder catheter + treatment of the cause (BPH → alpha-blockers + prostate surgery if necessary) → never prescribe an anticholinergic in this context (it worsens retention).
Consult at Clinique Omicron
Clinique Omicron physicians evaluate urinary incontinence disorders, prescribe bladder diaries and the ICIQ-SF questionnaire, perform urinalysis and measure post-void residual volume, refer to pelvic health physiotherapists for first-line pelvic floor rehabilitation, prescribe pharmacological treatments (mirabegron + anticholinergics), and refer to urologists or gynecologists for surgical procedures. Consultations are available at several service points across Quebec and via telemedicine. To book an appointment, visit cliniqueomicron.ca.
The content on this page is provided for informational purposes only and is not a substitute for advice from a doctor, physical therapist, or urologist. New-onset urinary incontinence or incontinence associated with blood in the urine requires a complete evaluation to rule out a serious organic cause.
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