Case history

Case history #1

A 40-year-old multiparous female presents to her primary care physician with a 10-year history of urinary leakage associated with coughing or sneezing. Urinary leakage began shortly after her third vaginal delivery and has gradually become more frequent. It also occurs during physical exertion and during intercourse. She is greatly embarrassed by this problem and has limited her social activities as a result. A medical history and drug review are non-contributory.

Case history #2

A 66-year-old female (gravida 3, para 2) presents with urinary urgency and frequency. She reports needing to urinate up to 12 times per day and 2 to 3 times during the night. Recently the urgency comes on so suddenly and strongly that she is unable to make it to the toilet and leaks urine. This often occurs just as she arrives home and steps out of her car or on arising from bed in the morning.

Other presentations

Urinary incontinence associated with both uncontrollable urgency and occurrence during strenuous activity is termed mixed urinary incontinence. Involuntary urinary loss may also result from urethral diverticula, genitourinary (GU) fistulas, and congenital urological anomalies such as ectopic ureters. Incontinence associated with urethral diverticula is often described as post-void dribbling or loss of an additional amount of urine at the completion of micturition. GU fistulas (i.e., vesicovaginal, vesicocervical, urethrovaginal, or ureterovaginal) are aberrant connections between the ureters or bladder and genital organs through which urine bypasses the normal sphincteric mechanism of the urethra and consequently leaks continuously. These are uncommon conditions. In resource-limited countries, GU fistulas may be seen after prolonged or obstructed vaginal delivery. In resource-rich countries, these fistulas more often occur after pelvic surgery, pelvic malignancy, or pelvic irradiation. Ectopic ureters are anomalous ureters that can terminate in the urethra or vagina causing leakage of urine.

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