Introduction

Learning objectives

Distinguish stress, urge, mixed, and overflow incontinence.
Know the components of the initial evaluation of incontinence.
Recognize the criteria that justify referral to a urologist.

Video lesson

▶

Video pending upload (embedded YouTube)

Summary

Urinary incontinence is the involuntary loss of urine.

Before referring, we should try to determine which type predominates:

Stress → leakage when coughing, laughing, running, or straining.

Urge → leakage preceded by a sudden urge to void that is difficult to postpone.

Mixed → a combination of both.

Overflow → associated with inadequate bladder emptying.

Initial evaluation

medical history;
medications;
urinalysis;
bladder diary;
physical examination;
postvoid residual when appropriate.

When to refer?

uncertain diagnosis;
hematuria;
recurrent infections;
elevated residual volume;
difficulty emptying;
suspected neurological disease;
significant prolapse;
failure of initial treatment;
consideration of invasive or surgical treatment.

PDF

⬇ Download lesson summary

Downloadable PDF pending upload.

Practical algorithm

🔴 Urgent referral / emergency

Sudden testicular pain → rule out torsion.
Fever/sepsis + obstructed urinary tract → urgent urinary drainage.
Acute urinary retention → bladder decompression; urgent referral if it cannot be resolved or if complications are present.
Hematuria + clot retention → urgent assessment and management.
Trauma + suspected urethral injury → avoid repeated blind catheterization attempts.

🟠 Priority referral

Solid testicular mass → rule out tumor.
Suspicious renal mass → characterization and urologic evaluation.
Gross hematuria → investigate the cause.
Persistently elevated PSA/suspicious DRE → prostate cancer risk assessment.

🟢 Scheduled referral depending on context

Recurrent UTI → look for a predisposing cause.
Erectile dysfunction → refer if complex, refractory, or with associated pathology.
Urinary incontinence → refer if complex, if warning signs are present, or if initial management fails.

The primary care physician does not need to resolve all urologic pathology. They must know how to perform an initial evaluation, recognize warning signs and, above all, distinguish which patient can wait from the one in whom a delay may compromise an organ, renal function, or even life.

Clinical case

Content pending upload Progressive clinical case focused on decision-making.

Self-assessment

Questions pending upload 5–10 multiple-choice questions on this lesson.

References

Links pending upload References to PubMed, DOI, scientific society guidelines and journals.

Urinary incontinence