Differential Diagnosis for Urinary Incontinence

The patient presents with a 9-month history of progressive loss of small amounts of urine, particularly while running, and has been diagnosed with a second-degree cystourethrocele. The differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Stress Urinary Incontinence (SUI): This is the most likely diagnosis given the patient's symptoms of urine leakage during physical activity (running) and the presence of a second-degree cystourethrocele. SUI is characterized by the involuntary leakage of urine on effort or exertion, or on sneezing or coughing, and is often associated with pelvic organ prolapse.

• Other Likely Diagnoses

  • Urge Urinary Incontinence: Although the patient's primary complaint is leakage during activity, which is more typical of stress incontinence, some patients with urge incontinence may also experience leakage with physical activity if their bladder is full. However, the primary symptom of urge incontinence is a sudden, urgent need to urinate.
  • Mixed Urinary Incontinence: This condition combines symptoms of both stress and urge urinary incontinence. Given the patient's history and the presence of a cystourethrocele, mixed incontinence is a possibility if she also experiences urgency or frequency.

• Do Not Miss Diagnoses

  • Neurogenic Bladder: Although less likely, neurogenic bladder due to a neurological condition (e.g., multiple sclerosis, spinal cord injury) can cause various types of urinary incontinence, including stress, urge, and mixed. It's crucial to rule out underlying neurological conditions, especially if other neurological symptoms are present.
  • Diabetes Mellitus or Diabetes Insipidus: Uncontrolled diabetes can lead to urinary incontinence due to polyuria (excessive urine production). While the patient's symptoms suggest stress incontinence, underlying metabolic conditions should be considered, especially if there are other symptoms like polydipsia (excessive thirst) or weight loss.

• Rare Diagnoses

  • Fistula: A vesicovaginal fistula, although rare, could cause continuous urinary incontinence. However, the patient's symptoms of incontinence only during physical activity make this less likely.
  • Urethral Diverticulum: This condition can cause urinary incontinence, recurrent urinary tract infections, and sometimes a palpable mass. It's a rare cause of incontinence but should be considered if other symptoms are present, such as post-void dribbling or recurrent infections.