From the Research
The next best steps for a patient with urinary incontinence and a scarred open proximal urethra should include both immediate management and further evaluation, with a focus on conservative measures and referral to a urologist for comprehensive evaluation and potential surgical intervention, as supported by the most recent and highest quality study 1. The patient should initially start with conservative measures such as:
- Pelvic floor exercises (Kegel exercises) and bladder training to improve continence
- Anticholinergic medication like oxybutynin (5 mg twice daily) or tolterodine (2 mg twice daily) to reduce urge incontinence
- Incontinence pads or protective undergarments for absorption and skin protection Concurrently, the patient should be referred to a urologist for a comprehensive evaluation of the urethral scarring, which should include:
- Urodynamic studies to assess bladder and urethral function
- Cystoscopy to visualize the extent of the urethral damage Based on these findings, the urologist may recommend surgical intervention such as urethroplasty to repair the scarred urethra, as suggested by studies 2 and 1. In the interim, consider intermittent catheterization if the patient has significant difficulty emptying their bladder due to the urethral scarring, and teach proper technique and hygiene to minimize infection risk, as recommended by studies 3 and 4. This approach provides immediate symptom relief while preparing for definitive treatment of the underlying urethral issue, which is crucial for long-term management of the incontinence, and is supported by the most recent and highest quality study 1.