Incontinence

Question 1

Muscarinic Receptor Antagonists and Anticholinergics

Answer 1

Reduce overactive bladder contractions
Used for urge incontinence and overactive bladder
Oxybutynin (Ditropan)
Tolterodine (Detrol)
Solifenacin (VESIcare)
Dicyclomine (Bentyl)

Question 2

Used when incontinence is related to BPH

Answer 2

α-Adrenergic Antagonists

5α-Reductase Inhibitors

Question 3

Finasteride (Proscar)

Answer 3

Reduces the size of the prostate gland to improve urine flow
Blocks the 5α-reductase isoenzyme (type 2), which is needed to convert testosterone to dihydroxytestosterone
Takes 4-6 months to be effective

Question 4

Dutasteride (Avodart)

Answer 4

Same effect, dual inhibitor of 5α-reductase isoenzyme 1 and 2
SE: decreased libido, decreased volume of ejaculate, ED
Monitor liver function tests

Question 5

*Alpha Blockers

Answer 5

-Blocks the α1-adrenergic receptors in the prostate smooth muscle to improve urinary flow

-May cause orthostatic hypotension

Examples:
Silodosin (Rapaflo)
Alfuzosin (Uroxatral)
Terazosin (Hytrin)
- Doxazosin (Cardura)
Tamsulosin (Flomax)
Prazosin (Minipress)

Question 6

Transurethral Resection of the Prostate (TURP)

Answer 6

The portion of the prostate that is blocking the urethra is removed

Procedure:
A resectoscope is inserted into the urethra via the penis and into the bladder
The portion of the prostate that has become enlarged is then removed

-Bleeding is common following the TURP procedure

-A continuous bladder irrigation (CBI) will be prescribed postoperatively with a LARGE indwelling Foley

To decrease bleeding and keep the bladder free of clots