Feasibility, Safety, and Reproducibility of Urodynamics in the Elderly

Resnick, Neil M.; Yalla, Subbarao V.; Laurino, Edna

doi:10.1016/s0022-5347(17)75492-4

Cited by 6 publications

(1 citation statement)

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“…Examples include women with symptoms and test findings of detrusor instability alone, or of isolated stress incontinence for which noninvasive therapy will be tried. However, if invasive or irreversible therapy is planned, the results of simple testing should be corroborated by formal urodynamic assessment; even in frail elderly such testing is feasible, safe, accurate, and reproducible 35 . Because of the prevalence of DHIC and its propensity to mimic urethral obstruction and stress incontinence, in elderly patients such testing should evaluate both the detrusor (preferably using subtracted cystometry) and the outlet (simultaneously and fluoroscopically, if possible).…”

Section: The Initial Approach To the Incontinent Elderly Patientmentioning

confidence: 99%

Initial Evaluation of the Incontinent Patient

Resnick

1990

J American Geriatrics Society

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lthough the optimal initial approach to incontinence is unclear for patients of any age, nowhere is there more uncertainty than for the A elderly patient. Only recently has incontinence in this age group been recognized as an abnormality worthy of attention and as a pathologic condition with a differential diagnosis and hope for improvement.As a result, neither a validated approach nor a consensus exists regarding the extent of the initial evaluation or the type of patient who should undergo more detailed testing. The answers to these issues will ultimately require simpler diagnostic approaches and a better understanding of the pathophysiology of incontinence, its response to treatment, and the characteristics of patients most likely to respond. Until such answers emerge, however, an interim solution is necessary. But to devise such an approach, one must first review the causes of incontinence, assess the accuracy of the clinical evaluation, and weigh the consequences of misdiagnosis. CAUSES OF INCONTINENCEContinence status is affected not only by lower urinary tract function, but also by environmental demands, mentation, mobility, manual dexterity, motivation, medications, and medical conditions. For incontinent younger individuals, factors outside the lower urinary tract rarely play a major role. But due to age-related and age-associated changes, these factors assume much greater importance in the elderly.Although there is still a dearth of data regarding the effect of age on lower urinary tract function-and no longitudinal studiesseveral points emerge from

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Section: The Initial Approach To the Incontinent Elderly Patientmentioning

confidence: 99%