Urodynamic Studies in the Management of Urinary Incontinence in the Elderly

The objective of this study is to characterize urinary incontinence observed in elderly women and to assess the importance of various parameters used to evaluate urinary incontinence. Two hundred consecutive, ambulatory, outpatient, incontinent women 55 years of age and over who were seen at the Continence Program Clinic and completed a medical and urodynamic protocol are included in this paper. After a thorough medical history and a complete physical examination, urodynamic tests were performed. The urodynamic results showed that 77% of incontinent women had an incompetent urethra. Twenty-five percent had a hyperactive bladder, 8% had "other" types, and 7% had a normal study. Comparison of the clinical diagnosis with the actual urodynamic diagnosis for stress incontinence revealed a 78% accuracy and only a 6% false negative. In contrast, a similar comparison for urge incontinence found only 44% accurate and 45% false negative. Analysis of the urodynamic tests revealed that the simple provocative full-bladder stress test was as effective as the radiographic or electronic pressure measurement in detecting incompetent urethra producing stress urinary incontinence. Provocative upright cystometry was helpful in uncovering 33% of hyperactive bladders not provoked in the supine position. Complex urodynamic tests should be reserved for unexplained incontinence or when symptomatology is complex.

Section: Discussionmentioning

confidence: 81%

Urinary Incontinence in Elderly Women: Urodynamic Evaluation

Diokno

Wells

Brink

1987

“…Whether or not impairments of physical function (especially mobility) and/or impaired cognitive function are primary causes of UI in most NH patients, the strong association of these impairments with UI has important implications for strategies to assess and treat UI in the NH setting. The appropriate extent of diagnostic evaluation for geriatric UI, especially with regard to urodynamic testing, is controversial 1,9–13 . Urodynamic tests can clearly identify abnormalities in lower genitourinary function that are amenable to specific types of treatment 20,21 .…”

Section: Discussionmentioning

confidence: 99%

Incontinence Among Nursing Home Patients: Clinical and Functional Correlates

Ouslander

Uman

Urman

et al. 1987

This study was undertaken to examine the association of specific medical and genitourinary conditions, medications, and functional disabilities with urinary incontinence (UI) in a nursing home (NH) population. Seventy-six incontinent and 38 continent patients in a Veterans Administration NH were studied. Incontinence was highly associated with each of the physical and mental functional disabilities we examined. However, with the exception of recurrent urinary tract infections and dementia, no specific clinical factors were significantly more common among incontinent than continent patients. Although precise causes for the UI were not determined, these data highlight the potential role of impairments of physical and/or mental function in the pathogenesis of UI among NH patients, and emphasize the need to address these impairments in future research on the assessment and treatment of UI in this population.

“…Most have involved young and middle‐aged women, have focused on urinary incontinence, and have attempted to correlate symptoms with lower GU tract dysfunction as defined by urodynamic testing 2 . Several studies have focused on the geriatric population 2–11 ; interpretation of many of these studies is complicated for several reasons, including: the relatively limited clinical, GU, and urodynamic findings reported; inconsistent terminology relating to urodynamic abnormalities; and potential selection biases in the study populations that cannot be ascertained from the data reported.…”

mentioning

confidence: 99%

Genitourinary Dysfunction in a Geriatric Outpatient Population

Ouslander

Hepps

Raz

et al. 1986

Clinical and urodynamic findings in 167 women and 96 men, aged 65 years and older evaluated consecutively during a four-year period in an outpatient urodynamic laboratory, are presented and compared with findings from other studies of geriatric populations. Seventy-three percent of the patients (81% of the women and 60% of the men) presented with symptoms of incontinence, most commonly of the mixed type. Although pathological lesions such as tumors and stones were rare, urodynamic abnormalities were common. Urodynamic evidence of sphincter weakness in women and detrusor motor instability were the most common urodynamic findings among patients who presented with incontinence. Close to 20% of patients who presented without incontinence also had one or more of these findings. Approximately one-third of patients had multiple urodynamic findings, emphasizing the complexity of the pathophysiology, diagnosis, and treatment of genitourinary dysfunction in many geriatric patients. Despite the long duration of symptoms in most patients, the majority were substantially improved after diagnosis and treatment of the specific genitourinary and urodynamic abnormalities detected.