1. When Your Patients Gotta Go!!!!! Raji Gill, D.O., M.Sc. Clinical Assistant Professor of Surgery Division of Urology Oklahoma State University

3. Incontinence Types Overflow / retention Stress / overactive

5. History Urgency, frequency, nocturia Incomplete bladder emptying Leak when straining Weak stream, post void dribbling

6. Past Medical Conditions Multiple sclerosis, spinal cord injury Diabetes Parkinsons Disease

7. Medications Worsen overflow Ephedrine (Rynatuss), pseudoephidrine, imiprimine (Tofranil) Worsen stress Clonidine (Catapress), phenoxybenzamine

8. Physical Check post void residual (PVR) Normal less than 50cc Abnormal more than 200cc Digital rectal exam Larger prostate (more than 40 gms)

9. Treatment Overflow / retention If PVR 50 – 200cc, timed voids, double voids If PVR > 200cc, straight cath or foley Stress / overactive Do not hold urine

10. Medical Therapy Overflow Alpha blockers act on smooth muscle receptors in the prostate (Hytrin, Cardura, Flomax) 5 alpha reductase inhibitor lowers dihydrotestosterone levels (Proscar, Avodart) Stress / overactive Anticholinergics for involuntary detrusor contraction (Ditropan, Detrol) Tricyclic anidepressants (Imipramine, Tofranil)

11. Surgical Therapy TURP, microwave therapy, thermotherapy for enlarged prostates Periurethral injections Urethral suspensions Sphincter prosthesis Sacral nerve stimulation

14. The End