The Pathophysiology of Urinary Incontinence among Institutionalized Elderly Persons

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

doi:10.1056/nejm198901053200101

Cited by 377 publications

(191 citation statements)

References 32 publications

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“…Feasibility of urodynamics in the elderly has been previously demonstrated (2). An unexpected result is the lower percentage of interpretable initial free uroflow (44%) compared with the 60.8% for the group of 748 women under the age of 80; the percentages were similar in the 2 groups for both IF and FF2.…”

Section: Commentsmentioning

confidence: 76%

Urodynamics in a community-dwelling population of females 80 years or older: which motive? Which diagnosis?

et al. 2010

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Purpose: To determine why community-dwelling women aged 80 years or over were referred for urodynamic evaluation despite their advanced age and which urodynamic diagnosis was made. Materials and Methods: One hundred consecutive females (80-93 years) were referred to our urodynamics outpatient clinic for evaluation of lower urinary tract symptoms (LUTS) between 2005 and 2008. Clinical evaluation comprised of a previous history of LUTS, previous medical history of neurological disease or dementia, pelvic floor dysfunction or prior pelvic surgery. Exclusion criteria were complete retention and severe dementia involving failure to understand simple instructions. Assessed items were results of uroflows (free flow and intubated flow), cystometry and urethral pressure profilometry, and final urodynamic diagnosis. Results: The main complaint evoked by the patients was incontinence (65.0%) of which 61.5% was "complicated" and urgency was reported by 70.0%. Interpretable free flow at arrival was very low (44.0%). Prevalence of detrusor overactivity was high, found in 45 patients of whom 16 had detrusor hyperactivity with impaired detrusor contractility. Detrusor overactivity and urgency were strongly associated (p = 0.004). Twenty-five patients had intrinsic sphincteric deficiency alone and 15 detrusor underactivity. Conclusion: In this particular community-dwelling with an elderly female population, urodynamics is easily feasible. Incontinence, mainly "complicated" is the more frequent complaint and urgency the more frequent symptom. Urodynamic diagnosis underlines the high incidence of detrusor overactivity as well as impaired detrusor function.

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Section: Commentsmentioning

confidence: 76%

Urodynamics in a community-dwelling population of females 80 years or older: which motive? Which diagnosis?

et al. 2010

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“…Detrusor overactivity and urge incontinence are clearly multifactorial (Mostwin, 2002;Resnick et al, 1989). Among potential causes, as argued above, neither increased bladder afferents nor ACG activation are plausible (although changed bladder afferents, specific to urgency, remain a possible causal factor).…”

Section: An Underlying Cerebral Cause Of Detrusor Overactivity?mentioning

confidence: 97%

Cerebral control of the bladder in normal and urge-incontinent women

et al. 2007

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Aim: To identify age-related changes in the normal brain/bladder control system, and differences between urge incontinence in younger and older women, as shown by brain responses to bladder filling; and to use age, bladder volume, urge incontinence and detrusor overactivity (DO) as probes to reveal control-system function. Functional MRI was used to examine regional brain responses to bladder infusion in 21 females (26 -85 years): 11 "cases" with urge incontinence and DO (proven previously) and 10 normal "controls". Responses and their age dependence were determined at small and large bladder volumes, in whole brain and in regions of interest representing right insula and anterior cingulate (ACG). In "controls", increasing bladder volume/sensation led to increasing insular responses; with increasing age, insular responses became weaker. In younger "cases", ACG responded abnormally strongly at large bladder volumes/strong sensation. Elderly "cases" showed strong ACG responses even at small bladder volume, but more moderate responses at larger volumes; if DO occurred, pontine micturition center (PMC) activation did not increase. Conclusion:Among normal "controls", increasing age leads to decreased responses in brain regions involved in bladder control, including right insula, consistent with its role in mapping normal bladder sensations. Strong ACG activation occurs in urge-incontinent "cases" and may be a sign of urgency, indicating recruitment of alternative pathways when loss of bladder control is feared. Easier ACG provocation in older "cases" reflects lack of physiological reserve or different etiology. ACG responses seem associated with PMC inhibition: reduced ACG activity accompanies failure of inhibition (DO).

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“…The ICI-CDT advises that elderly patients should not be considered differently from younger subjects simply because of their chronological age; however, the committee recommends to bare in mind age and gender relevant changes in ''normality'' of UDS, when performed in (frail) elderly. 29,30 UI in frail elderly people may be the result of a number of contributory factors, many of which are reversible by conservative and non-invasive measures; the ICI-CDT recommends that such patients are first evaluated by a clinician skilled in the care of older people before any invasive investigations, treatments, or medications are advised to the patient. Because of the multifactorial nature of UI in the elderly, the ICI-CDT recommends to consider easily reversible causes or contributory factors for UI to primarily initiate conservative therapies.…”

Section: Urodynamic Testing Frail Elderly With Signs And/or Symptoms mentioning

confidence: 99%

Executive summary: The International Consultation on Incontinence 2008—committee on: “Dynamic Testing”; for urinary or fecal incontinence. Part 2: Urodynamic Testing in male patients with symptoms of urinary incontinence, in patients with relevant neurological abnormalities, and in children and in frail elderly with symptoms of urinary incontinence

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Gajewski

et al. 2009

Neurourology and Urodynamics

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Aims:The members of 'The International Consultation on Incontinence 2008 (Paris) Committee on Dynamic Testing' provide an executive summary of the chapter 'Dynamic Testing' that discusses (urodynamic) testing methods for patients with signs and or symptoms of urinary incontinence. Testing of patients with signs and or symptoms of fecal incontinence is also discussed. Methods: Evidence based and consensus committee report. Results: The chapter 'Dynamic Testing' is a continuation of previous Consultation reports added with a new systematic literature search and expert discussion. Conclusions, based on the published evidence and recommendations, based on the integration of evidence with expert experience and discussion are provided separately, for transparency. Conclusion: This second part of a series of three articles summarizes the committee's recommendations about: 'Urodynamic testing of male patients with symptoms of incontinence, of patients with relevant neurological abnormalities, testing of children and of frail elderly with symptoms of incontinence' and includes only the most recent and relevant literature references. Neurourol. Urodynam. 29:146-152, 2010. ß 2009 Wiley-Liss, Inc.Key words: consensus committee; incontinence (children); incontinence (frail elderly); incontinence (male); incontinence (neurologic); urodynamics INTRODUCTIONSubsequent to the first two reports of the International Consultation on Incontinence (ICI) 1,2 the chapter ''Urodynamic Testing'' was renamed ''Dynamic Testing'' in the third and fourth reports because of the additional inclusion of recommendations on the (diagnostic) management of fecal incontinence. 3 We (members of ''The ICI 2008 Committee on Dynamic Testing'': ICI-CDT) provide an executive summary of the chapter ''Dynamic Testing'' in the fourth ICI-report on incontinence. 4 The ICI-report, with the ICI-CDT chapter discussed here, has the intention to provide recommendations on the basis of the most reliable evidence for the current state of assessment of the patient with urinary or fecal incontinence. To this aim, dedicated and systematic literature searches were performed on the basis of keywords and on the basis of articles related to references in the previous ICI-reports. Throughout the chapters' text ''conclusion(s)'': solely and entirely based on the published scientific evidence, and ''recommendation(s)'' are highlighted. The ''recommendations'' are the integration of scientific evidence with the expert group consensus, together with the discussion with the attendees during the ICI meeting. Conclusions are separated from recommendations to produce maximum transparency about the ''evidence base'' of the recommendations. Likewise obtained ''topics(s) for research'' are also highlighted in the text of the ICI-report. In this executive summary, we discuss the chapter ''Dynamic Testing'' from the ICI-report in three parts: The innovations in urodynamic techniques ''in general,'' the test characteristics and normal values of urodynamic studies (UDS) as well as the asse...

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The Pathophysiology of Urinary Incontinence among Institutionalized Elderly Persons

Cited by 377 publications

References 32 publications

Urodynamics in a community-dwelling population of females 80 years or older: which motive? Which diagnosis?

Urodynamics in a community-dwelling population of females 80 years or older: which motive? Which diagnosis?

Cerebral control of the bladder in normal and urge-incontinent women

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