Incontinence, urinary diagnosis

O Accurate diagnosis and classification of urinary incontinence type is critical to the selection of appropriate drug therapy. 

Urinary incontinence can result from abnormalities within (intrinsic to) and outside of (extrinsic to) the urinary tract. Within the urinary tract, abnormalities may occur in the urethra (including the bladder outlet and urinary sphincters), the bladder, or a combination of both structures. Focusing on abnormalities in these two structures, a simple classification scheme emerges for all but the rarest intrinsic causes of UI. Accurate diagnosis and classification of UI type is critical to the selection of appropriate drug therapy. 

The diagnosis and treatment of bladder dysfunction and urinary incontinence in horses is rather primitive compared with that in human patients with these problems (Wise Cardozo 1994). In humans, the management of these conditions includes a variety of procedures (e.g. exercises, behavioral therapy and surgery) as well as adjunctive drug treatment. Finally, urine scalding is not a problem in human patients with incontinence because they can either wear protective garments or be taught to self-catheterize. 

A 45-year-old woman with resistant rheumatoid arthritis was given etanercept 25 mg twice weekly. Nine days later she developed total acute sensory loss, with flaccid paraplegia, fecal incontinence, and urinary retention. MRI imaging and cerebrospinal fluid analysis were consistent with a diagnosis of transverse myelitis. She also had positive antinuclear and anticardiohpin antibodies. After etanercept withdrawal and treatment with dexa-methasone and cyclophosphamide, her motor function improved with no change in sensory function. 

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