Case Study #1

Case Study #1 A 51-year old otherwise healthy woman presents to her primary care physician with complaints of feeling the urge to void after dropping her child off at school every day. She manages not to void before entering the house, but sprints to the bathroom to avoid urinary incontinence. She is going on her “dream vacation” to Tuscany in two weeks and wants HELP!” How would you evaluate this patient? What is the likely diagnosis? What is a reasonable treatment plan? What are reasonable expectations for pharmacological therapy?

Case Study #2

Case Study #2 A 39-year old woman is healthy and takes no medications. She reports wetting her underwear small amounts after vigorous workouts at the gym. She denies nocturia, and has 8 micturitions per 24-hour period. How should this patient be evaluated? What treatment options should be offered?

Case Study #3

Case Study #3 A 64-year-old woman reports at 2 or more episodes of significant urgency per day, and a constant desire to void that interrupts her activities. She has nocturia x2, and reports one or two episodes of wetting her clothes when unable to find a toilet at the mall and the airport. These symptoms that have been increasing in the last year. In addition, she reports urinary loss with coughing (she has had increased coughing–new allergies?) or lifting. She restricts her fluid intake, has stopped alcohol beverages and caffeine and voids before taking car trips. ACE inhibitor (new) and HCTZ for hypertension. Fluoxetene for depression. Oral estrogen since menopause. She was treated previously with a “bladder drug” that resulted in minimal dry mouth, but bothersome constipation and somnolence.

Case Study #3 (cont) What should the components be of her initial evaluation? What is the probable diagnosis? Should this patient’s initial treatment plan consist of behavioral therapy alone, and if so, what should this be? Or, should initial approach to treatment consist of pharmacologic therapy? Is it likely that this antihypertensive agent, antidepressant or estrogen has anything to do with the patient’s urinary complaints? Should this patient be referred to a urologist, and if so, why?

Case Study #5

Case Study #5 A 60-year-old woman complains of daily urinary incontinence x 5 occurring with urgency and loss on the way to bathroom. The symptoms also occur when coughing, laughing, or sneezing, although they are less bothersome during these episodes. She has had recurrent urinary tract infections. What is the likely provisional diagnosis? Is behavioral therapy a consideration in this patient? Devices? Medications? Surgery?