Case 1

A  44 year old G4P4 woman complains of a 3-year history of loss of urine 7 to 8 times each day, typically occurring 2 to 3 sec after coughing, sneezing  or lifting weight. She also notes dysuria and the urge to void during these episodes. These events cause her embarrassment and interfere with her daily activities. The patient is otherwise in good health. A urine culture performed 1 month previously was negative.On examination, she is slightly obese. Her blood pressure is normal. The breast examination is normal without masses.Systemic examination reveals no abnormality. The abdominal examination reveals no masses or tenderness. A midstream voided urinalysis is unremarkable.

• What is the most likely diagnosis?
• What is your next step?
• What is the best initial treatment?

ANSWERS & DISCUSSION WILL BE POSTED NEXT MONTH.