doc4mindia
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A 78-year-old man has recurrence of incontinence associated with overactive detrusor function. Over the past three weeks, the patient has had progressive improvement in response to increasing doses of propantheline.
The most appropriate next step in management is to:
a. Restrict fluids
b. Switch to Imipramine
C. Measure postvoid residual volume
d. Perform cystoscopy
e. Perform cystometry
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| almozaffar
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I think performing cystoscopy is the most legible one, coz we have to know the impact of urine retention and reflux existence in long-term cases
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thanks a lot
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| dimps
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i agree with almozaffar
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hi how r u
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| doc4mindia
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The answer is C
Nocturia, urinary urgency, and urge incontinence may be caused by multiple factors. The differential diagnosis in older men should include detrusor dysfunction, urethral obstruction, and overflow incontinence. Radiographic imaging of the urethra during voiding is the most effective study to evaluate detrusor dysfunction, outlet obstruction, and overflow incontinence. Urge incontinence is the most common type of incontinence in older persons and is frequently attributed to detrusor overactivity.
A postvoid residual volume determination is useful for evaluating overflow incontinence. Cystometry is useful for evaluating detrusor dysfunction. It can detect uninhibited contractions if the amplitude is sufficient. It does not, however, assess the outlet and is not useful in differentiating primary uninhibited contractions from contractions secondary to prostatic obstruction. Measurement of urinary flow rate is also not useful to assess obstruction. A low flow rate, even when corrected for voided volume, is not a reliable indicator of outlet obstruction.
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