Urethral underactivity

Vaginally-administered estrogen plays only a modest role in managing stress urinary incontinence (urethral underactivity), unless it is accompanied by local signs of estrogen deficiency (e.g., atrophic urethritis or vaginitis). 

The goal of pharmacologic therapy of urethral underactivity is to improve the urethral closure mechanism by one or more of the following ... 

Mixed incontinence includes the combination of bladder overactivity and urethral underactivity. 

Differentiating Bladder Overactivity from Urethral Underactivity... 

Urethral underactivity is known as stress Ul (SUl) and occurs during activities such as exercise, lifting, coughing, and sneezing. The urethral sphincter no longer resists the flow of urine from the bladder during... 

Duloxetine (when approved for treatment of urinary in- continence), a-adrenergic receptor agonists, and topical (vaginal) estrogens (alone or together) are the therapies of choice in urethral underactivity (stress incontinence). 

This type of UI is known as stress urinary incontinence (SUI). Although the exact etiology of urethral underactivity and SUI in the woman is incompletely understood, clearly identifiable risk factors include pregnancy, childbirth, menopause, cognitive impairment, obesity, and age. The prevalence of SUI in women appears to peak during or after the onset of menopause. This implies that hormonal factors are important in maintaining continence. 

Various types of UI may coexist in the same patient. The combination of bladder overactivity and urethral underactivity is termed mixed incontinence. This is often a difficult diagnosis to make because of the often-confusing array of presenting symptoms. Bladder overactivity may also coexist with impaired bladder contractility. This is most common in the elderly and is termed detrusor hyperactivity with impaired contractility. ... 

CLINICAL PRESENTATION OF URINARY INCONTINENCE RELATED TO URETHRAL UNDERACTIVITY... 

Urinary incontinence—Involuntary leakage of urine. May result from urethral underactivity (stress urinary incontinence), urethral overactivity (overflow incontinence), or mixed pathophysiologic mechanisms. 

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